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More kids are showing up in ERs with anxiety, depression and other common mental health problems: why isn’t nutritional psychiatry part of the discussion?

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This article on NBC news, More kids are showing up in ERs (Emergency Rooms) with mental health crises, reports large increases across the country.

Dr. Anna Abrams, a pediatrician and researcher at Children’s National Medical Center in Washington, finds the numbers both shocking and disheartening.

In the 5-year period from 2012 to 2016, when looking at ER mental health admissions in 45 children’s hospitals, they found the following increases:

  • 48 % in white children
  • 64% in non-Hispanic black children
  • 77% increase in Hispanic children

with about a 55 % increase overall.

Dr. Abrams and her colleagues presented these findings at the American Academy of Pediatrics conference in earlier this month.

Other than the very large increases, there is something else to be concerned about: the researchers say they aren’t sure why we are seeing these increases, speculating it “could be due to the scarcity of mental health professionals who can help children” and “People are also talking more openly about depression, anxiety and other common mental health problems and that may make parents feel more comfortable about seeking help for their children.”

While these are very valid reasons, we really do need to be incorporating nutritional psychiatry (a term coined in 2015) and functional medicine (Dr. Mark Hyman is one of the leaders in functional medicine) into these discussions, studies and conferences. Other than poor diets and nutritional deficiencies we need to be considering stress, exposure to toxins, poor gut health and increasing Wifi exposure, to name a few.

If we look at diet alone, there is so much recent research supporting the connection between diet and mental health. Here are two of many new studies:

Despite some contradictory results, overall there was support for an association between healthy dietary patterns or consumption of a high-quality diet and lower levels of depression or better mental health. Similarly, there was a relationship between unhealthy diet and consumption of low-quality diet and depression or poor mental health.

These data suggest that Iranian adolescent females eating a pro-inflammatory diet…had greater odds of having at least moderate depressive symptoms.

And here are just a few other factors to consider:

How do we get this nutritional psychiatry research and case studies into the hands of those who can change actually policy and the way mental health is addressed? I believe it has to be a grass-roots effort from the bottom up and I have these suggestions:

  • share this blog and the research with your doctor and/or allied health practitioner
  • reach out to study authors, journalists and legislators and share research and success stories like the above, and your own personal results
  • if you’re a practitioner, write blogs like this sharing the good results you see with your clients and patients – with researchers, journalists and legislators
  • share in forums and on social media, and with your neighbors, friends and family
  • comment on blogs like this – with success stories in your family or with clients – so more people get to see what really is working

Every little bit helps! I’d love to hear your ideas too.

Most children with anxiety relapse, regardless of treatment: Now is the time for Nutritional Psychiatry!

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Most children with anxiety relapse, regardless of treatment! This is the title of a recent article on Medscape and is just heart-breaking to read. The article is reporting on a presentation from the 2017 Anxiety and Depression Association/ ADAA conference: Results from the Child Adolescent Anxiety Multi Modal Extended Long term Study CAMELS.

As a nutritionist educating and consulting with individuals with anxiety, using nutritional and biochemical approaches with great success, this is just not acceptable. I know we can do better and now is the time to be incorporating nutritional psychiatry. I’ll go as far to say let us start with nutrition.

Here is the message from the Medscape article (you will need to create a userid and password to be able to view it online)

Children treated for anxiety disorders with psychotherapy, antidepressants, or a combination of the two show no significant differences in outcomes or remission at 5-year follow-up. Furthermore, a majority of children experience relapse and chronic anxiety, new long-term data show.

Scott Compton, PhD, associate professor of psychiatry and behavioral sciences at Duke University School of Medicine, in Durham, North Carolina comments on the study:

For the majority of children with anxiety, the results … suggest that anxiety might be best characterized as a chronic disorder that needs to be managed.

With that in mind, further tailoring is needed to more individually address patients’ needs

As a field, we need to shift our approach away from a ‘one protocol fits all’ to figuring out how best to sequence treatments for the sizeable percentage of children who do not respond to current evidence-based interventions.

I don’t think Dr. Compton was thinking about nutrition when he said this but clearly the current evidence-based interventions are not working for most children and this is where nutrition comes in.

I also feel that anxiety should not be seen as a condition that has to be managed, instead we should be sharing the message that it can be eliminated, and providing long-term solutions to achieve this.

Here is the comment I posted on the article (and I also reached out to the study authors and shared this via email):

Research like this further confirms that we need to be incorporating nutritional interventions and biochemical approaches. We now have the results of the SMILES diet depression trial (published January 2017): the first randomized controlled diet depression study where ONE THIRD of the dietary intervention group saw improvements in their depression symptoms.  This was just diet alone and switching from processed/junk food to real food with no specific dietary restrictions. Participants also reported improvements in anxiety symptoms.  

When we customize diet we see further improvements and examples include the removal of gluten, caffeine, sugar and the addition of quality animal protein (especially at breakfast), organic vegetables and fruit and healthy fats. Addressing specific deficiencies is key too: low zinc, low iron, low serotonin, low GABA, low vitamin B6, low vitamin D etc. And addressing gut health and balancing the microbiome is imperative. There is research supporting all of the above and it’s effective in clinical practice – it simply needs to be part of the treatment of care for all anxious individuals.

A wonderful organization is the International Society for Nutritional Psychiatry Research (ISNPR).  Their first international conference will be held in Bethesda in July this year.  Another excellent conference is IMMH/Integrative Medicine for Mental Health. For practitioners in Australia, the MINDD forum is an excellent resource.

I would love to see more collaboration between practitioners and researchers in the nutritional/functional medicine/nutritional psychiatry space and practitioners and researchers in traditional psychiatry.  I feel we have so much to learn from each other.

My hope is that we can open communication and start to collaborate in order to serve all the anxious children and adults with all the options we have at our disposal!  

As stated in this 2017 paper – Nutritional Psychiatry: Where to Next? nutritional psychiatry is an emerging field and

offers much promise for addressing the large disease burden associated with mental disorders. A consistent evidence base from the observational literature confirms that the quality of individuals’ diets is related to their risk for common mental disorders, such as depression [and anxiety].

This is the case across countries and age groups. Moreover, new intervention studies implementing dietary changes suggest promise for the prevention and treatment of depression [and anxiety].

Concurrently, data point to the utility of selected nutraceuticals as adjunctive treatments for mental disorders and as monotherapies for conditions such as ADHD.

Finally, new studies focused on understanding the biological pathways that mediate the observed relationships between diet, nutrition and mental health are pointing to the immune system, oxidative biology, brain plasticity and the microbiome-gut-brain axis as key targets for nutritional interventions.

Here are just a few additional links with research supporting nutrition for anxiety:

And here is some feedback from individuals who have benefited from some of these approaches:

If you are a practitioner who works with anxious children or adults use these resources to stay at the cutting edge of nutritional psychiatry.

If you have children with anxiety or are someone who suffers from anxiety, use this information to be informed of the latest research and be sure to share this with your practitioner.

And please let me know if you have any questions. As always I love to hear success stories so feel to share those too.

GABA for children: ADHD, focus issues, irritability, anxiety and tantrums

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Is GABA safe for children with symptoms of ADHD? I was asked this question after my interview on anxiety on the Diabetes Summit. I shared the question and my answer on facebook:

I’ve used GABA (and theanine) very successfully with children with physical anxiety symptoms and ADHD. I’ve also used tyrosine for the attention/focus issues. Plus I always consider gluten, blood sugar control (animal protein at breakfast often makes the biggest difference), colors/additives, low iron, low zinc and candida (this list is not inclusive but is a good starting point)

Jenny is a mom in my facebook community and responded to the above post, sharing that a friend of hers recommended GABA for her daughter after reading some of my posts. She shared this wonderful feedback:

My daughter hasn’t been diagnosed with ADHD but has a lot of ADHD qualities. We were having a huge amount of behavior problems as she is getting older (she’s 11). I did some research and went to the health food store and bought a bottle. At this point I was mentally exhausted from all the fighting and drama at home and at school. I was desperate and didn’t want to put her on any hard medication.

She has had amazing behavior at school and at home since giving it to her. She’s almost like different child. GABA has truly changed our life. She’s been taking it for almost 2 months.

What wonderful results! I’m thrilled for Jenny and her daughter. I asked Jenny to share what her daughter’s symptoms/behaviors were before they used the GABA and which symptoms improved. This is what Jenny shared:

…before the GABA she was irritable, she was fighting with her teacher and schoolmates, she couldn’t focus and was distracted by anything and everything, she was constantly disrupting the class and she was throwing major tantrums over ridiculous stuff (like her hair didn’t do what she wanted), she was mouthy and everything was a fight.

We are not seeing 99% those behaviors at all anymore. She of course is still your typical pre-teen but if I say “no you can’t have that” our “no you can’t go there” her reaction is OK. Before it would have been a major fight or meltdown. Her teacher is reporting to me every day about her wonderful days.

I love hearing this feedback and it’s not unusual for children to act out when they have low GABA levels. Adults may identify with being anxious, but children may appear irritable, unfocused and distracted, may have tantrums and meltdowns, and all the while not be able to articulate how they are feeling.

Long–term use of GABA and root causes of low GABA

Jenny also posed some additional questions about GABA:

I do have some questions – I can’t really find anything online saying that it’s OK to give to kids. I mean, I’ve seen the results but it still worries me. She takes one 25 mg pill a day – do you think that’s OK?? Should I give her more or less or keep it the same? Just wondering your opinion?

I shared some of this feedback on the facebook thread and have elaborated on it here on the blog.

There is no research on children and the long-term use of amino acids but plenty of clinical evidence showing they can be used safely for 3-12 months. But I am also always working with my clients to find out why there is the deficiency in the first place and addressing that. This could include any or all of the following:

  • low zinc/vitamin B6/low iron which are all co-factors needed to make GABA (and then I’d want to know why are these low)
  • dysbiosis, parasites and/or candida (we make GABA in the gut and we may have GABA-eating bacteria in the gut – such as gabavorous)
  • too much stress at school, playing sports and/or at home
  • not getting enough sleep
  • not eating animal protein at breakfast (this affects blood sugar control and can stress the adrenals and impact cortisol, sex hormones and brain chemicals)
  • gluten sensitivity (gluteomorphins in gluten can impact mood and gluten can damage the gut leading to nutritional deficiencies)
  • low animal protein intake and/or eating a low-fat diet
  • low stomach acid (so you can’t digest the protein you’re eating)
  • toxin exposure (like pesticides or BPA)
  • low total cholesterol (caused in part by low levels of enzymes for fat digestion or a low-fat diet)

I shared these 60+ Nutritional and Biochemical Causes of Anxiety on my closing call of the The Anxiety Summit season 3.   I use this to help put the puzzle pieces together for my clients to resolve their anxiety and related issues like ADHD, insomnia, sadness, irritability etc.

When Jenny saw some of the root causes for low GABA she shared that she’s going to be making an appointment with her doctor. Keep in mind that in this instance it will need to be a functional medicine doctor or nutritionally trained doctor or a doctor who is open to learning about all this. I always also suggest taking a copy of my book The Antianxiety Food Solution to share with the doctor too!

What GABA product?

I typically have clients start with Source Naturals GABA Calm which contains 125mg of GABA. I was curious to know which 25mg GABA product she was using. It turns out to be a sublingual product by KAL.

  

 

You can find the other GABA products I use and recommend here and the precautions with using GABA here. Typically it’s an amino acid that the least issues, unless too high an amount is used.   I often hear that 500mg or 1000mg was used and caused dizziness or breathlessness – these are clues it’s too much!

I asked Jenny if I could share here to give other mom’s hope and inspiration and practical results so they can help their children – and really I appreciate her being willing to do so.

Thanks for sharing Jenny! Happy mama and happy daughter – it warms my heart to hear stories like this!

Have you used GABA and observed a reduction or elimination of ADHD, irritability or anxiety?

If you’re a practitioner, have you seen results like this with your clients or patients?

Low zinc and low GABA contributing to anxiety in children and women

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low-zinc-gaba-video

Dr. Nicole Beurkens and I sit down together at the end of the recent Integrative Medicine for Mental Health conference to talk about anxiety and the impact of both low zinc and low GABA. Nicole shares her perspectives on working with children and I share what I see with the adult women I work with. We don’t specifically talk about older adults or men but it’s applicable to everyone.

Dr. Nicole Beurkens PhD, a special educator, clinical psychologist and nutritionist, is author of the new book Life Will Get Better: Simple Solutions for Parents of Children with Attention, Anxiety, Mood and Behavior Challenges

In case you’re new to my community, this is my book: The Antianxiety Food Solution: How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings

Here are some of the highlights from our conversation about zinc:

  • Zinc is a very common deficiency and can be a contributing factor in both anxiety and ADHD
  • Zinc is depleted by sugar consumption, stress and exercise
  • Zinc sulfate used as a zinc challenge is one way to determine your zinc status
  • Nicole’s response to the zinc challenge: fuzzy, strong yukky taste – which means good zinc levels
  • Most people coming to the booth had very little reaction to the zinc challenge – which means low zinc levels
  • Level 1, 2, 3 and 4 are used to figure out your zinc status (you can read about the zinc taste test here)
  • My response to the zinc challenge: metallic, gross, horrible and I got goosebumps – – which means good zinc levels
  • Nicole shares that most of kids and young adults at her clinic have level 1 or level 2 zinc status, and it’s an easy test to do with kids
  • Many people at the conference were on zinc and were surprised they were not tasting the zinc sulfate. Other than sugar consumption, stress and exercise, low HCl (stomach acid) can affect your absorption. I also found that many of these folks were on a gluten-free or Paleo or GAPs diet and eating a lot of nuts or using nut flours. Nuts are high in copper and this can counteract the zinc.
  • We talk about the importance of good quality zinc supplements and finding a zinc product and multi that is copper-free. Here are the products I recommend.

Then we talk about GABA Calm, a calming amino acid that we both love! Here are some of the highlights from this section:

  • It’s a lozenge/sublingual, is easy to take and helps in situations where the anxiety can quickly escalate into panic attacks. Nicole likes the peppermint flavor and finds many of the children and young adults she works with prefer the orange flavor. Personally I also prefer the orange flavor.
  • For adults, if you use wine at the end of the day to de-stress, you may be low in GABA and self-medicating, and using something like GABA-Calm often helps.
  • Moms will take their GABA Calm with them and use as needed and give to their kids if needed too.  
  • I share how effective it is for Lyme anxiety and how it can be used instead of benzodiazepines (I interviewed Trish about this on the recent Anxiety Summit)
  • GABA Calm can help when you’re on a benzodiazepine and even very severe anxiety or depression can be alleviated with diet and nutrients.
  • Nicole shares how common benzodiazepine prescriptions are in teens and young adults; and the issues with dependence and wanting to quit but not being able to. It can sometimes take years to reduce the medications.
  • I share about the first World Benzo Awareness Day on July 11 – so many people are in trouble and are not cautioned.

We were both so encouraged being at this conference and seeing so many physicians, psychiatrists, psychotherapists, psychiatric nurse practitioners and others practitioners who are really interested in learning more about these approaches. They are seeing the same issues we see with some of the medications (and not getting to the root cause of anxiety) and they are excited to expand their knowledge base. It’s just so exciting to see the pendulum swinging!

We both really appreciate the Integrative Medicine for Mental Health conference. If you’re a practitioner and haven’t attended it’s a must-attend event. If you were there you know what I mean. It was also super to meet so many of you after my talk and at my booth. If you’re not a practitioner do tell your doctor about it. Save the date for 2017: September 28 – October 1 in Orange County, California.

We did this as a live video feed on Facebook hence the references to posting questions and Facebook. It was also the end of the event and the people next to us were packing boxes and using a lot of tape so apologies for the weird noises.  

Feel free to share your results with zinc and GABA Calm and any questions you may have.

The Anxiety Summit – Anxiety in children, adolescents and young adults: an integrative psychiatric approach

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Zendi Moldenhauer_Anxiety4

Dr. Zendi Moldenhauer, PhD, NP, RN, is interviewed on the Anxiety Summit by host of the Anxiety Summit, Trudy Scott, Food Mood Expert and Nutritionist, author of The Antianxiety Food Solution.

Anxiety in children, adolescents and young adults: an integrative psychiatric approach

  • The incidence of anxiety in children: official stats and real life numbers
  • How to identify anxiety in children and the IBS-anxiety connection
  • Medication over-prescribing, hidden side-effects and electroshock
  • Food, toxins, gut health, the adrenals and an integrative approach
  • How to use calming theanine and GABA

Here are some gems from our interview:

…anxiety disorders in children are probably the most common psychiatric disorders that start in childhood.  And depending on studies and depending on how anxiety is defined the rates are anything between 10 to 30 percent.  Less common in younger ones and more common in teenagers.  But really the lifetime prevalence of that is a child or teenager developing anxiety sometime up to age 18 is somewhere between 25 and 30 percent. That means one in three to one in four children or adolescents at some point during that time period which is very high.

…when somebody has an anxiety disorder they’re more like to have more than one anxiety disorder because they could have generalized anxiety disorder or social anxiety disorder or separation anxiety or panic disorder.  So it’s really very common like up to 60 percent of patients with anxiety disorder can have another anxiety disorder or depression or ADHD. 

And that’s just sort of more the mental health disorders.  There’s also an incredibly high association between anxiety and IBS.  In fact nearly half to three-quarters of children with IBS can have anxiety.  So there’s a huge relationship between anxiety and other mental health disorders but anxiety and other physical disorders like gut issues or headaches for example.

Here are some of the studies we discuss related to IBS and anxiety:

Dr. Zendi shares that children can’t necessarily identify that they’re anxious: 

Children with anxiety can often not express that they’re anxious.  And if you can imagine a five or six or seven year old they don’t necessarily come to us and say mommy, I feel anxious about whatever is going on in their lives.  So often with children we see it through their behavior.  So children who are either nonverbal at all or haven’t yet developed the emotional language to describe anxiety act out anxiety.  So you might see a child that’s more withdrawn and doesn’t want to participate, doesn’t want to leave the house, doesn’t want to get on the school bus, doesn’t want to go to school, doesn’t want to participate in activities.  There’s a lot of avoidance kind of behavior. 

We discussed this article in Scientific American – The Hidden Harms of Antidepressants: Data about the true risks of suicide and aggression for children and teens taking these drugs have been suppressed

And this one about ECT: American Psychiatric Association Lobbies FDA to Electroshock Children  https://www.cchrint.org/2016/05/05/apa-lobbies-fda-to-electroshockchildren/

We covered organic food and the EWG dirty dozen list for fruits and vegetables

Dr Zendi’s go to nutrient for anxiety and adrenal dysfunction is theanine:

which is an amino acid derivative from green tea and it’s thought to really cross the blood brain barrier and exerts a variety of neurophysiological and even like pharmacological effects on the brain in terms of its anxiolytic and calming effects because it actually upregulates inhibitory neurotransmitters like GABA and possibly modulates serotonin and dopamine in specific areas of the brain.  It actually also increases alpha wave activity.  So children can either sleep better because they’re sleeping at a deeper level or they feel more calm and focused during the day without feeling drowsy so there’s no side effect to L-Theanine which is great. 

Here are two of the theanine papers we discussed:

Here is Dr. Zendi’s digital gift: Practical Tips for Parents of Children and Teens with Anxiety and Irritable Bowel Syndrome (IBS) 

 

If you are not already registered for the Anxiety Summit you can get live access to the speakers of the day here: www.theAnxietySummit.com

Missed this interview or can’t listen live? Or want this and the other great interviews for your learning library? Purchase the MP3s or MP3s + transcripts and listen when it suits you.

You can find your purchasing options here.: Anxiety Summit Season 1, Anxiety Summit Season 2, Anxiety Summit Season 3, and Anxiety Summit Season 4.