This is the month for me to practice what I preach!
School's out today, which means routines change - that's stress...
I'm moving to a new house - that's a lot of stress...
So what to do about it? My approach in the past would have been simply to wait it out. I would have plowed ahead, figuring I'll recover soon enough.
But that approach isn't ideal. Stress does really bad things for you, some of which wear away at your health year after year. It also causes you to think and plan differently (if at all), which means you could be stuck with decisions your best self would not have made.
You have probably heard about all the bad things stress can do. Isn't stress normal, you say? Shouldn't we be designed to deal with it?
The theory goes like this:
Mammals tend to be well-adapted to acute stress. Something scary occurs, we get a whole body reaction, leading us to be ready for flight and fight. This whole body reaction includes anxiety (you don't want to be "relaxed" when the lion attacks), increased glucose (for fuel), and shutting down body functions that can be put off to later. These include fighting infections, repairing body parts, cleaning out toxins, learning new tasks, feeling happy and connecting intimately with others.
This system works fine unless the stress continues to affect us for many hours, day after day. And the sort of stress that works exactly like this is what you get when you have a big brain and you mull over problems endlessly, without even meaning to.
Robert Sapolsky argues that "zebra don't get ulcers" because when the lion leaves the scene, satisfied or not, the zebra essentially "forgets" anything happened and snaps back to its relaxed, grass-eating mode. On the other hand, when the test or interview is over, or the huge bill is paid, humans continue to worry about the long-term outcome.
The hormone that becomes a problem when we ruminate, or mull things over, or allow our brain to run away with thoughts of possible doom, is cortisol. All manner of ills result from chronically elevated cortisol, including alteration of gene expression, which can be hard to reverse.
So left to its own devices, stress causes us to express genes that tend towards anxiety and high blood glucose, impaired immunity, weak body components and poor detoxification, decreased ability to relax and connect intimately.
How do you fight it actively?
1. Exercise - at least a 20 minute walk
2. Yoga, journaling, meditation, taking deep breaths (25 a day!). These activities actually boost the hormones that signal relaxation to your body.
3. Eating foods that repair damage within the body - phytonutrients, antioxidants, fiber
4. Getting a good amount of high quality protein so there's enough left over after the body has highjacked some for cortisol-mediated functions
5. Learning to work with your brain - consciously changing underlying beliefs that get you carried away overinterpreting reality in ways that end up harming you. Explore a research-proven tool like Emotional Brain Training, or Scott Noelle's approach to parenting.
6. Scheduling in fun, or going with it spontaneously. Building in opportunities for a good, clean laugh, lots of hugs, chances to help others and be supported by them
Once the stressful time is over, or even if it's never over, you'll be that much healthier, stronger, wiser and more connected.
SUMMARY OF THE IMMUNE SYSTEM
It is a truly awesome, amazingly complicated phenomenon, with two systems (the innate and acquired systems), and dozens of different cells that turn each other on and off and cause each other to make new proteins and behave in new ways. I think one way to make it understandable without having to get an advanced degree is to talk about its main functions:
1. recognize intruder
2. get a response going
3. destroy intruder
4. damage control
5. cleanup crew
TO EXPAND ON THE ABOVE:
1. Recognize intruder
It’s important to know what is dangerous (a bacteria that could kill you, such as some of the dangerous pneumonia strains), what is not dangerous (ragweed pollen for example, or peanut butter), and what is a part of your own body – in some illnesses, the immune system attacks your own body cells.
Too much or too little immune response starts here: too little and you might get overcome by a dangerous bacteria; you may also fail to detect and destroy cancer cells. Too much means you overreact to something that’s not dangerous, or attack some of your own body cells.
2. The cells that do the recognizing need to communicate with the cells that get the response activated. This usually happens by direct contact. In turn, the activated cells broadcast a general body call to action by manufacturing and secreting pro-inflammatory mediators. There are several types of pathways for this: one is the classical allergic response: sneezing, itching, hives, runny nose. But there are other responses too. With viruses, for example, you get a whole body feeling of being ill: temperature, tired, achy, irritable or gloomy.
3. Activated immune cells in your body attack intruders in a variety of ways. Some of them eat up germs. Some actually throw bleach at them. The cells also call more troops to the site. Blood vessels are made to become leaky so immune system cells can get into the area where the infection is and make contact with the intruder. This is why an infected site swells up, like your skin, or your nasal mucosa. Damage occurs because attack chemicals cause injury to our cells too. Here you start to get the sense that if there wasn’t a system to put the lid on this, it would eventually chew you up.
4. But there is a suppressor system. It gets under way as soon as the actual immune response begins. The suppressor cells secrete specific chemicals that slow down the activation from step 2. What is interesting is that some bacteria that normally live in our gut can also make this same chemical. This is another place food and toxins can have an influence. If you’re eating very little fiber and you don’t have enough of this bacteria, any intruder can cause too much of an immune response. Also if you’re eating the wrong fats, it pushes forward the formation of chemicals that stimulate more immune response. One way to slow this down is by balancing the omega6:omega3 ratio of food. Another way is by slowing down the enzymes that turn fatty acids into pro-inflammatory molecules.
5. The cleanup crew restores the body to its previous healthy state. This involves tissue repair and shutting down the process. Note that repair tends to occur while you sleep. Memory of this encounter stays with the immune system, so the next encounter will be fought off more efficiently. Very importantly, you need anti-oxidants in your system, because one of the major chemicals released in this process are “reactive oxygen species” that cause direct chemical damage inside your cells. ROS also cause additional inflammation. Anti-oxidants and detoxifiers are responsible for “quenching” the ROS and getting them out of the body.
You get the sense that the ideal immune response is like a surgical strike: specifically targeted, and precisely calculated to disable the intruder without collateral damage. For this, you need a finely tuned immune system.
WHERE THIS SYSTEM BREAKS DOWN
The illnesses that appear to be increasing significantly in recent years have important immune components:
1. Allergies are overreactions to non-dangerous intruders; so two things happen here. First the recognition system is making a mistake; second, the immune activation is not being shut down fast enough. Very different chemicals sometimes look alike. Some parts of bacteria can look just like molecules inside your joints. Parts of GM corn look just like dust mite allergen. There’s a lot of opportunities for the immune system to be get us into trouble.
2. Chronic diseases, such as atherosclerosis, appear to be the result of ongoing immune system activation. Cholesterol deposits in the blood vessel walls isn’t really dangerous without inflammation. When you have immune system activation within the deposits, however, the inflamed cholesterol plaques can swell and rupture and throw off a clot that causes a heart attack or stroke.
3. Depending on your genetics, your body might be overreacting to specific molecules in the food. In some cases these molecules are caused by cooking methods. For some people, the yummy brown substance that appears when you cook foods a certain way, called “advanced glycation end-products”, sets up an immune reaction. Boiling and steaming tends to be safer in this sense, than stir-frying and roasting, and in turn they are safer than barbecueing and broiling.
4. Chronic diseases seem to be connected to each other. For example, one important predictor of survival for a heart attack patient is the presence or absence of depression. On one level this seems obvious – depressed people can have a weaker will to live, and so they die after their heart attack. But how does this work, and what does this tell us about inflammation, toxins, and food? Depressed individuals have more inflammation – some of this “depression” is actually the gloomy effect of the pro-inflammatory mediators.
5. To prove this, they actually injected some of these mediators into normal volunteers. They all started feeling achy, tired, discouraged and gloomy. It was hard to tell some of them apart from depressed people. The conclusion is that certain foods, and certain conditions like gum disease, can fan the flames of an ongoing inflammatory response that could sink you into a depression. Or at the very least, your diet can add to your troubles and make you unresponsive to therapy or Prozac.
6. Another way this could happen is if you eat foods like GMOs or too much sugar, and/or are exposed to toxins that make the intestines leaky. Bt, for example, is a pesticide we use to kill caterpillars by giving them a very leaky gut. GM corn contains a gene that causes the corn to make its own Bt. However, this means that when you eat the corn, you also eat large amounts of Bt. I know, humans are not caterpillars. However, research shows that Bt from GM corn causes leaky gut in mammals. The danger is that large molecules from food (casein, gluten) can then enter the bloodstream and set up an intruder alert. This alert is either the type that gives you hives and itching, in which case the situation is easily recognized as an allergic reaction. But if the response, instead is fatigue, muscle aches and general irritability, you will only get puzzled looks from your doctor, a guess that maybe you are fighting off a virus, and a recommendation to lower the stress in your life.
7. We are getting both more food allergy (like anaphylaxis to peanuts) and food intolerance (people who don’t feel good after eating normal things like wheat flour, corn or soy). There is a short list of the foods that cause trouble in 90% of the cases where there is trouble: dairy, eggs, wheat, soy, fish, shellfish, nuts.
8. The food you eat “talks” to your DNA. Changing your diet, according to one experiment by Dean Ornish (in Sausalito), within 2 months, causes a change in the expression of at least 200 genes. Within 2 months of eating whole, organic food, chosen for its rich content of nutrients, you are essentially a new person. In another experiment, GM food fed to mice caused altered gene expression of more than 400 genes. Whole different mice. Mind you, Monsanto does not allow anyone to use their products for experiments. So these experiments are done on other GM corn. Why is this DNA issue relevant? Well, when we say “activated immune cells”, we mean immune cells that are expressing their DNA differently than before. So much of what happens to us happens through regulation of gene expression.
9. Dr. Ornish and others also claim that most cases of breast cancer and prostate cancer are diseases of inflammation. Changes in the immune system would be involved in the formation of these cancers.
10. Many claim that ADHD and diseases on the autistic spectrum also relate to the immune system. There have been autopsies of autistic children who die as passengers in cars, for example. A Harvard pathologist examined some of these brains and described inflammation within brain structures. In other words, they contained immune system cells that seemed to be trying to fight something off. With ADHD, 60% of the kids, according to a recent study from Sweden, responded with significant behavioral improvement to a diet as outlined above. The hope, in my mind, would be that you could take out the foods that cause problems, repair the gut, remove the conditions that caused leaky gut in the first place, then return to a full diet.
SPECIFIC FOOD ISSUES
Remember the definition of a toxin: something that enters the body and causes harm.
1. Artificial toxins
These include manufactured chemicals for food coloring, flavoring, preservatives, stabilizers, pesticides and herbicides. There is a very long list on the Center for Science in the Public Interest website also available as an iPhone app (http://www.cspinet.org/reports/chemcuisine.htm). A pet peeve for me is “natural flavor” on the ingredient list: most processed foods do not bother to extract flavors from actual produce. The word “natural flavor” means that it tastes like something natural. It does not mean there is an extract from a natural food in there. “Caramel color” is another tricky one. CSPI lists it as carcinogenic. Artificial colors and pesticides cause hyperactivity in children, one within minutes, the other developmentally.
2. Natural toxins
In the setting of increased intestinal permeability, a variety of normal molecules from food can become toxins. This is because large proteins tend to set off an immune response. These proteins would normally be stuck in the intestine long enough to be broken down into smaller molecules. Small molecules just don’t trigger this type of thing, so our intestinal cells are supposed to have a tough barrier. Toxins and certain foods make this barrier leaky. You can suspect you have leaky gut if it seems like many foods cause problems. Many doctors have never heard of this - they just need to do more updating. It’s normal for research to take 20-30 years to make its way into clinical practice. Just google “pubmed intestinal permeability name of favorite disease, like asthma, eczema, fibromyalgia, etc…” and see what you can find.
Mercury in fish; arsenic in chicken (from chicken feed disinfectant); Some chemicals, which are lethal in high doses, were thought to be safe enough in small amounts. However, now we are finding out that in small amounts, they just have more subtle, but no less devastating, effects.
4. “Too much” toxins
In large amounts, fructose, which is normally found in fruit, causes insulin resistance, problems with cholesterol and triglycerides, and inflammation.
5. Overbred food
Through systematic breeding, wheat has lost 40% of protein content in the last 60-70 years, and has too much gluten, because that makes for light white bread. Apples are also much higher in sugar; in colonial times, they were used only for hard cider (Johnny Appleseed was responsible for quite a few alcoholics). Even tomatoes (according to the canning literature) are higher in sugar now than just a couple of generations ago. I would say that is also true of carrots, peas and corn (looking through gardening catalogs, it seems like many of the seeds are called things like “super sweet” etc…) Produce is bred for shelf life, yield and cost-efficiency. Breeding for taste also doesn’t guarantee nutrition, though there’s some evidence that tastier produce has more phytonutrients. Maybe breeding for color would best correlate with nutrition.
6. Depleted soils
We don’t even know what is in healthy soil and plants. For proper immune function you need magnesium, zinc, copper, selenium, manganese, and so on… There are 8,000 phytonutrients in plants. The combinations may be key. It’s crazy to even think about relying on vitamin supplements. I like to hedge my bets and I do both, but if I had to pick only one, I would choose to rely on healthy food, grown on well-cared for soil. Some studies show that plants grown with extra nitrogen, for example from synthetic fertilizers, end up with lower levels of some nutrients. It’s like raising kids – they love you when you feed them a cookie, but if you do it every day, for every meal, you end up with problems. Produce grown with pesticides also tend to have lower levels of some nutrients, because they haven’t had the “stimulus” – I guess when they get munched on, they turn on the protection factors.
7. Nutrient and amino acid absorption
Certain medications, and also stressful states, and even what you think about when you are eating influence nutrient absorption. It’s overwhelming, but it’s also very hopeful and restores a sense of control to the individual.
8. Bacteria, viruses, molds, yeasts
9. Artificial food
To me genetic modification does go a step beyond breeding. Plants will go ahead and use the DNA we inject in ways we can’t control. While the DNA is supposed to be a template, it doesn’t actually work flawlessly. As these genes are inserted, mistakes are made. There are several examples of deadly GMO foods that “almost” made it to market, and one example where a GMO-made supplement killed 100 people in Japan. Also, patenting food is very dangerous. Can you imagine Monsanto taking control of the food supply? Don’t we have safeguards against monopoly? Monopoly over lipstick is one thing, but over the food supply?
Besides, GM food has been shown to be dangerous to the immune system in several important studies. Several of Monsanto’s own studies were obtained by court order, re-analyzed and found to indicate unacceptable risk of harm. And Monsanto isn’t content to patent a product or two – they take over control of key crops: corn, alfalfa, soybeans – even cash crops like cotton. This is not reasonable. And anyone who thinks the FDA is looking into this should know that the lawyer for Monsanto actually developed the regulations on GMO food at the FDA, then became FDA assistant director, and now is the food safety czar for the Obama administration.
Finally, they do something very strange when they sue farmers for growing GM crops, just because the wind carried the pollen over to a farmer’s field. It’s a serious problem when you can be prosecuted for not preventing what is unpreventable. With the approval of GM alfalfa, it may become impossible to grow organic alfalfa, in which case no milk will be organic, as almost all cows are fed alfalfa. Of course we know the organic industry has been a thorn in the side of agribusiness, but how is it that our right to choose is being taken away?
WHAT YOUR FOOD SHOULD DO FOR YOU
Given the way this system works, and how the intestine is such a large place of contact with the outside world, it stands to reason that food becomes a most important reason for diseases of immunity, either too active, or not active enough.
1. First, we need the right building blocks
The building blocks for our body structures come mainly from food. Some of the molecules can be made in the human body, but many can’t. They are called “essential” – either fatty acids, amino acids, or vitamins and minerals. We have to eat enough essential nutrients to be healthy. We have to absorb what we eat. Also, if we eat too many calories, we produce too much oxidation, and this in itself causes an overactive immune state.
2. The process of building must proceed correctly
Building is done by enzymes, which are proteins the body builds using the code in the DNA. Many of them need vitamins or minerals as “co-factors”, or helpers. Without them, the chemical reactions occur too slowly or not at all. These include magnesium, copper, zinc, selenium, iron, manganese, sulfur, and many more. It’s daunting to realize that we need all of these to function optimally. Severe vitamin deficiency causes “deficiency diseases” like scurvy, within weeks. Mild deficiencies are now thought to cause “long-latency diseases”, that manifest after a few decades. Unfortunately, there are few reliable tests for the function of these co-factors. It’s not enough to measure them in the blood or urine. They go to work inside cells – and we don’t have a lot of affordable, well-studied intracellular tests. The solution ends up being to provide most people with a good diet +/- a multivitamin supplement.
3. Friendly bacteria must be kept happy
These are ancient beings that live on fiber, vitamins and minerals, and that do poorly when soaked in sugar and strange processed chemicals. In turn, they are intimately involved in every building, repair, regulation and detoxification process within our bodies. Bad bacteria can play a number of tricks, such as make “psychoactive” substances! At the very least, an unhappy gut environment causes inflammation, and when pro-inflammatory mediator levels rise, you get a tired, itchy, grumpy, gloomy human.
4. The intestinal surface must be kept intact.
We depend on it to keep out toxins and molecules that would be recognized as “dangerous strangers” by our immune system. You can repair leaky gut with a combination of diet, targeted herbs and nutrients.
5. The diet must be rich in anti-oxidants
We should focus on a daily abundance of anti-oxidants and phytonutrients. Oxidation is a normal by-product of energy metabolism, but it causes cell damage and needs to be addressed. At the same time, plants offer combinations of nutrients that detoxify and are generally involved in hundreds of processes throughout the body.
MORE GENERAL HEALTH RECOMMENDATIONS
1. The whole body must be conducive to health
Naturopaths believe that you don’t fight disease: you create the conditions under which the body can find its way back to health. You need to look at all the systems. For example, hormonal imbalance such as estrogen excess causes inflammation. Think about all the substances we hear about as being estrogen mimics (BPA, but also all the other plastics, as it turns out; Teflon, Stainmaster, flame retardants, pesticides).
2. Several nutrients work together
We tend to believe that we are fairly healthy, so at any given time, any problem must be due to a single deficiency. This is incorrect. In most adults, a combination of deficiencies is usually at the root of problems. Any attempt to improve immunity will have to involve a comprehensive approach. Otherwise, what you get is a different imbalance. One of my teachers, Dr. Alex Vasquez, has a minimum 5 part intervention: DIET, omega-3 fatty acids, vitamins/minerals, vitamin D, probiotics. Each of these support the other 4. Adding only omega-3 fatty acids, for example, will cause a problem if your diet is based on refined carbohydrates. Antioxidants pass toxic molecules from one to the other down a chain. If any of them is deficient, the entire system will not work correctly. Vitamin D gets special status because most people need large doses and you need to keep track of the situation with blood tests.
3. Another whole body issue you need to address is stress.
Under stress conditions, the body is protein-deficient because it is busy making pro-inflammatory mediators. So many of these mediators are made that muscle must be broken down to supply amino acids if there aren’t enough in the diet. On the other hand, too much protein in the diet is bad too. The solution is to reduce stress, by reducing external circumstances but also by directly convincing the body to dial down its stress response. Exercise, yoga, participation in like-minded groups are just a couple of ways this is done.
4. If the above isn’t enough, you can address specific targets
Some people have sluggish immune cells, or unstable mast cells, or too few white blood cells. These can be addressed directly with herbs or medications. This is a last resort, though, and sometimes hopefully a temporary issue.
We can avoid the vast majority of GM foods. Basically we have to eat non-processed food, and we can’t eat anything prepared by someone we don’t know – we have to know where all the ingredients came from. I guarantee you will be healthier for it.
Before you reject the notion out of hand, consider this:
1. Fruit, nuts, berries, and many vegetables are essentially fast food. You can grab some instead of chips or crackers, or pastries.
2. Studies show that cooking from scratch actually involves something like 10 minutes extra compared to heating up a TV dinner. We can brainstorm solutions audience members have come up with.
3. Problems come up more when you are on the go, or traveling, or the babysitter has to feed the kids – but you don’t have to be perfect. The difference you get from changing 80%, or even 60% of your diet will be worth the effort.
4. Cost-wise, it is likely that buying produce and fruit will result in savings over the cost of processed food like cereal, deli lunch, crackers, desserts. You pay more per nutrient when you eat processed food. There will be a period of adaptation where you long for the crunch of your favorite processed food, but it’s not long until you start to look forward to a daily salad lunch. Your kids may have to rely on too few foods at first, but little by little they get used to seeing green and orange things on their plates and eventually eat them. They will still pine for brownies and ice cream, but will also get excited when you bring strawberries and peaches home from the market.
5. Honestly, it is hard to give up certain foods. Pies, French fries, tomato sauce, ice cream, macaroni and cheese – these are the yummy foods that take time to make, and that you will have to find creative ways to work around – either you begin to spend a lot more time in food preparation, or you give them up entirely, or you make exceptions. In the case of most healthy food, it’s not so hard to find alternatives that are organic and made with healthy ingredients.
This is not a reason to avoid getting started. By loading your shopping cart with fruit, colorful vegetables, nuts, berries, seeds and healthy meats, you quickly transform your family’s diet. By adding daily exercise and time with friends, you lower your stress level so that dietary change no longer seems overwhelming. Honestly, I also think that my daily multivitamin gives me the energy to spend more time in the kitchen. It could be placebo, but if it works, I won’t knock it!
So what if it takes two years? One day, you look at a box of processed snack food and you start to think: Is cottonseed oil really edible? That’s a lot of sodium, no? What is the unpronounceable stuff? I think I’m better off getting some apples and yogurt. That’s when you remember that 200+ of your genes have been altered by your healthy habits, and you’re no longer the person who couldn’t resist Cheezits.
TIPS FOR IMPROVING IMMUNE FUNCTION
DETOXIFICATION: “CLEAN UP” AFTER THE IMMUNE SYSTEM DOES ITS JOB
10 HABITS OF THE MASTER DETOXIFIER
1. Avoid toxins – we hope to give people convenient ways to do this.
2. Exercise – works on many levels to return the body to an anabolic state
3. Stress reduction, lots of it – most powerful technique is deep breathing: five deep belly breaths lasting 5 seconds, repeat 5 times per day. Yoga, dancing, friends, singing, hobbies, journaling, meditation, prayer, psychotherapy, support groups. Building community is huge here, as well as finding something that keeps you engaged – the sort of work volunteers do at groups like MOMAS provides that outlet for us!
4. Stress avoidance – this becomes a way of life; opting out of the rat race; considering stress in making decisions, doing less; simplicity parenting
5. Foods that encourage Phase II; one or two daily for everyone; more if you are working to overcome health issues. See list below.
6. Fiber – crucial for binding toxins, and for feeding healthy bacteria; this means plants.
7. More foods that encourage healthy bacteria – yogurt with probiotics, fermented foods; puer tea; raw milk and cheese likely also contain probiotics.
8. Diet low in sugar, white flour, processed foods – the effects of a bad diet are multiple. Basically it results in a fright mode, or catabolic state.
9. Diet low in foods that encourage inflammation; See notes below – definitely avoid: corn oil, soybean oil, factory meats including fish.
10. Whatever it takes to keep the body’s elimination going smoothly: 8 glasses of water, regular bowel movements, sweating.
The food list: Garlic, onions, rosemary, green tea, flaxseed, turmeric, berries, cruciferous vegetables (especially broccoli sprouts and watercress), folate and B vitamins, chlorella. Eggs are an important source of sulfur for supporting Phase II.
SUPPORT A HEALTHY AND BALANCED IMMUNE SYSTEM
Non-gluten grains: brown rice, millet, quinoa, amaranth, tapioca, buckwheat
Fruits and vegetables (whole, not juiced)
Fish (small amounts, given our overfished oceans and rivers)
Healthy meats (100% grass fed beef, well-raised pork, rabbit, chicken) and eggs
Legumes: peas, beans, lentils
Nuts and seeds (except peanuts and pistachios – they can be inflammatory)
Preferred oils: olive, flaxseed, expeller-pressed sunflower, sesame, walnut, pumpkin, almond
Cayenne, rosemary, oregano, turmeric, ginger, purple grapes, thyme, onions, apples, tea
Cinnamon, cumin, garlic, dill, oregano, parsley, coriander, tarragon
Honey: local, dark (wildflower), unpasteurized; don’t heat it.
Any form of wheat, oats, spelt, rye, kamut, barley and products containing gluten
Shellfish (shrimp to clams), sweeteners (except honey); dried fruit sometimes too sweet as well.
There’s controversy around animal fats; Weston-Price foundation recommends fish and grass-fed animal products, encourages cooking with bacon grease, and eating full-fat animal products. However, they also recommend lots of broths made from bones, fermented foods, fermented cod liver oil and special butter oils made from animals eating special fast-growing grass. They could be right…
Other sources recommend limiting animal products because of the risk of contamination by heavy metals and other toxins, and because they are rich in omega-6 fats.
As we won’t ever understand all the intricacies of this system, please make your own decision based on values and careful consideration.
I've been thinking of doing a post for a while, trying to organize the diverse and abundant information I have been gathering on ADHD.
This is a bit of an opinion piece. This is my emerging understanding of this problem based on reading the functional medicine literature. I am not so interested on suppressing symptoms by using medication for years on end. I am interested in finding underlying causes, the simpler the better, in an effort to return the person to a state of health.
To those who say ADHD is normal, just boys being boys, etc... I say - living with it in one's family quickly reveals this is simply not the case. It's not just that kids with ADHD need to move around a lot. There's something about emotional self-regulation, and being able to plan ahead to get what one wants, that's simply missing in these kids, and this makes life for them and those responsible for them, painful at times.
So I believe, something needs to be done. What to do will depend on the individual.
At this point in my retraining as a functional medicine physician, I understand ADHD (and autism, and autism spectrum disorders) as being the end result of a variety of possible impacts on the child's development. These disorders appear to involve inflammation, which means that the immune system has something to do with it. They also involve genetics, as revealed by studies of family members and twins. They very much involve the environment, as revealed simply by the fact that their incidence is rising. This is clearest for autism, simply because autistic children are very hard to overlook, or fail to diagnose. It is more murky for other neurological issues.
The other thing I am reading about is that they involve problems with energy utilization within the brain. There are abnormalities on scans of blood flow to various parts of the brain. This does not tell us what causes these blood flow issues. There are also abnormalities in the way some parts of the brain work at the cellular level. Mitochondria seem to be affected. Neurotransmitters are most definitely affected.
These disorders also sometimes involve xenobiotics. That's a fancy word that means "chemicals that aren't normally in the body" - they include chemicals invented by humans, such as pesticides, and poisons from the environment such as lead and mercury. These tend to accumulate in fatty tissues within the body, and the brain is made up of fat.
ADHD involves problems with essential fatty acids. These are components of food that are assimilated by the body and used up to build cell membranes and other crucial working cell components.
So, treatments that reverse ADHD have involved a variety of approaches. Most work a little on their own, and much better in combination with other treatments. Here's a long list, along with a little comment as to how they fit into the whole picture.
Diet plays a huge role. Some chemicals, such as artificial coloring, causes hyperactivity in "normal" children, and certainly make children with ADHD worse. Elimination diets improve symptoms in a large majority of the kids who can actually stay on the diet (and a majority of kids do stay on the diet). Beliefs on various diets have come and gone. This latest blockbuster is from a study published in 2011.
If ADHD involves significant inflammation, then it stands to reason that interventions that reduce inflammation would also reduce symptoms. Typically, there are 5 major steps to reducing inflammation:
1. The first, is a return to a caveman diet: nuts, berries, fruits, vegetables, seeds and lean sources of protein. Watch out for the fish (mercury), and the animal protein should come from grass-fed, free-ranging animals. Lean is supposed to be better because pesticides accumulate even in organic animals, given their presence in the air we breathe.
2. The vitamin D status should be checked and corrected.
3. Essential fatty acids, usually in the form of high quality fish oil, are likely to work. One study reports giving more EPA than DHA, another reports giving more DHA, less EPA. It may simply depend on the child. A blood test for these could help guide treatment. This is rarely done in the research.
4. Multivitamins are a good idea because the child's need for antioxidants, B vitamins, zinc, magnesium, iron, and vitamins C and E is likely to be high. These vitamins and minerals are affected by stress levels, which tend to rise when someone's behavior is constantly a source of grief. Also, the antioxidants especially help protect the fatty acid supplements from harm within the body.
5. Exercise is an important component of treatment for ADHD. I think this is because exercise reduces stress. It also helps the body make new mitochondria, which are supposed to be affected. Exercise affects the brain, allowing it to make new neurons, and connections between neurons.
6. Probiotics may be a good idea (I haven't seen published research here) because gut dysbiosis (the wrong bacteria) is an important component of inflammation. Getting the bacteria right could help heal the gut, which in turn would decrease potential for mischief from digestive issues. I know this is vague, but it appears that "bad" bacteria are making chemicals from food in our intestines, that then enter the bloodstream and affect behavior. Weird, but apparently true...
7. Some researchers have seen success with medium doses of two amino acid precursors: 5-HTP and tyrosine. A majority of children begin to do better just days after starting on these supplements. Some of the children who don't respond at first, do finally respond when the doses of supplements are adjusted according to results of urine tests for amino acids.
8. Direct stress reduction, such as the use of the HeartMath monitor, have also had some success.
Suppose you have a child aged 3-18, either diagnosed with ADHD, or who seems to you scattered, overly active or absent-minded in the extreme - what can you do that seems reasonable, that doesn't involve expensive testing and specialist visits, and might avoid the use of stimulant and other medications?
A. I would go ahead and do the above diet. It is a very healthy diet that eliminates GMOs and processed foods with weird ingredients. It is strange at first, but grows on you and seems the only reasonable way to eat. Things are changing quickly - food allergies are up dramatically, and some physicians are claiming that 40% of us are gluten intolerant.
B. I would add fish oil, about 1g daily. I am partial to Nordic Naturals, because they seem to pay attention to harvesting fish sustainably, and to the quality of the product: no mercury, no rancid oils. They have it tested by an independent laboratory. There are other brands that can be recommended by someone who is knowledgeable concerning supplements.
C. If you use fish oils, then you have to use a good quality multivitamin. Here, too, I would get advice from someone who uses and understands supplements. The brands at the store unfortunately don't usually have enough B vitamins, or even C vitamins. Or they lack vitamin A, or don't have much vitamin D. Or they have the wrong kind of folate or vitamin E. It's hard to know what you need exactly, but these are pretty basic.
D. Instead of probiotics, you can use fermented foods, the problem is which one. If milk turns out to be okay, you could use kefir, but otherwise, you have to hope you child likes sauerkraut or kombucha.
E. Exercise would round out this intervention as a general recommendation. Daily, a 30 minute walk or bike ride, or other activity, and yoga would be awesome if you can get it to happen.
I'm imagining that if you did all this, you would see a clear improvement. It still might not be enough to get off all medication, in which case you would want to consult with someone well-versed in functional medicine, or a really good homeopath. It becomes detective work, and sometimes breakthroughs happen by chance.
This was the document on which we based the first presentation of the Modern Moms' Health Forum, in April 2011. This series of forums is presented by MOMAS (was: “Mothers of Marin Against the Spray”, now changed to “Moms Advocating Sustainability”) and thus is focused on the effects and avoidance of environmental toxins.
Our first presentation focused on water, and also on food, with special attention to the needs of families. The team that put this forum together is comprised of one pediatrician, one family physician, a public policy analyst, and three well-informed volunteers.
Future meetings will address issues related to the air we breathe, exhaust, volatile organic compounds, persistent organic pollutants such as flame retardants, fumes from cookware, pesticides, electromagnetic fields, GMOs, and whatever else is on your mind. Please let us know with your questions and comments.
A short word about our speakers:
Michelle Perro, MD, D.HOM. is a pediatrician and homeopath in private practice at “Down to Earth Pediatrics” in Fairfax.
Myrto Ashe, MD, MPH, is a family physician raising three boys in Larkspur. She graduated from family medicine residency at Brown University in 1990, and got her masters in public health at Berkeley in 1996. She worked in community health centers for about 20 years before quitting to focus on her boys 3 years ago. As it turns out, focusing on the boys also became focusing on local organic food and health issues such as environmental toxins. She will be opening a private practice in the fall specifically to help people with stubborn medical problems.
Let’s first discuss the general topic of toxins.
A toxin is something that
- is taken into the body AND
- can cause damage to body structures
- and/or disturb normal physiological function
The body has a sturdy detoxification system, and one of our tasks is to learn to work with it. Why do we have such a system? Well, this is basically the body’s waste disposal system: every time a hormone is secreted, or a neurotransmitter is made, it is not reused. It is disposed of, and new hormone or neurotransmitter must be synthesized in the amounts needed. Also, the body produces waste in the process of creating energy from the food we eat, for example. All this has to be sent out of the body, through the breath, sweat, urine and feces.
For now, let’s consider a couple of types of damage toxins cause:
- DNA damage: some toxins go up to the DNA inside a cell and can stick to it and turn genes on or off. This can lead to cancer, but also perhaps to diabetes or immune problems.
- Cell death: some toxins cause cells to overheat.
- Interference with the work of enzymes making proteins or neurotransmitters
Now let’s look at what ways the body has of protecting itself:
- Barriers: the skin, the intestine, and the lungs are three important places that come into contact with toxins, and where it’s best to let fewer things pass through. Some toxins damage barriers.
- Binders: the body works with substances that stick to toxins and help them pass out of the body as waste products. Fiber is one important such substance.
- Biotransformation: the body has substances whose job it is to chemically change toxins, molecule by molecule, so they can be carried out of the body.
WHY IS THERE A PROBLEM WITH TOXINS IN THE ENVIRONMENT?
If toxins are normal, and we are equipped to deal with them, what is the problem?
- The problem is that there are too many. We have added 80,000 new chemicals to our environment since 1945. Also, we have moved things around so that for example mercury is now in fish we eat, and the air we breathe, instead of being safely bound up in rock.
- Another problem is that our diet has changed, so we don’t necessarily get the nutrients we need to take full advantage of our detoxification system. Also the soil has been depleted, so that even “healthy” food potentially does not contain the nutrients it once did.
WHAT’S IN THE WATER
There are two major areas of concern when you consider water. First, the water we drink and cook with. Second, the water we bathe or swim in. But actually, Marin water (MMWD) is not too bad.
This is how it works: water gets contaminated either at the source (with pesticides, or radon), or at the treatment plant (MMWD uses disinfectant to fight germs), or in the pipes leading to your house or school (if they leak lead, for example). The major problem in Marin water is "products of disinfection", so MMWD is part of the problem. Several municipalities, including Sacramento and San Francisco, have far better drinking water than we do. The Environmental Working Group found that in Marin, 8 chemicals exceeded health guidelines, and 17 additional pollutants were found. This is mostly the result of disinfection and has been linked to cancer rates.
In other parts of the country, tap water can have the following issues:
- metals: lead, mercury, cadmium, arsenic
- medications: antibiotics, hormones, antibacterials from liquid soap
- radiation from old surface tests of nuclear missiles
- rocket fuel
- pesticides and fertilizers
The ones relevant to Marin County appear to be:
- radon, which leaches from soil into the groundwater, but typically adds only a small fraction to your home level, and is more of a problem in the shower
- chemicals left over from the disinfection process (trihalomethanes, or THMs)
It would seem like a good idea to get bottled water to drink, however,
Bottled water also has issues:
- much of it comes from tap water somewhere else
- it’s regulated less stringently – less frequent quality control
- you are at the mercy of equipment malfunction at the bottling plant
- it comes in plastic bottles, which leach out toxins
- there are also social and environmental issues
Ideally you would test your water for lead, using a home kit or the state laboratory.
Then, you would decide whether to get a filter for drinking and cooking water. Most important for lead, but maybe also for THMs. Finally, you would test your home for radon, and then depending on the level, consider a shower filter for radon (carbon-based should work fine here). The effect of THMs in shower water are not known.
Water we bathe and swim in has the following issues;
- some of the toxins, mostly radon, get inhaled when you shower, or pass directly through the skin – it makes most sense to have house tested for radon
- depending on your level of concern, you can consider saline swimming pools (chlorine is definitely a respiratory irritant and carcinogen, though "saline" swimming pools don't just contain salt, so who knows how safe they are...) and more infrequent baths (to reduce THM exposure through the skin).
- what you put in the water: triclosan (the ingredient in antibacterial soap) is a hormone modulator; fragrance (often listed in the ingredients) is a likely carcinogen, and can cause hormonal issues. Do you really need to use bubbles, soap, shampoo? Whether these are toxic or not, you introduce an additional load of chemicals to your baby’s body. We did find online recommendations for “least-toxic” bath products, but they are imperfect.
MORE ON THE BIOCHEMISTRY OF DETOXIFICATION
I want to address the issue of whether substances are toxic or not. We hear a lot about chemicals being “safe’” and in my experience, that’s just simply an overstatement sometimes. First of all, only 250 out of the 80,000 chemicals out there have even been tested on humans. Even the ones thought to be safe have not been tested in combination with each other. Why is that important? Here are the results of a real experiment:
We know that lead and mercury are toxic. In sufficient doses, they are deadly to both humans and other animals. But this is how toxins work: in smaller doses, they are deadly to only a few individuals out of a sample of animals. In this experiment, they used the dose of lead that can be expected to kill 1% of the animals in the experiment. But they also gave the animals, at the same time, a dose of mercury that would be expected to kill only 1% of them. The result was death in 100% of the experimental group, within 5 days.
Tracey Woodruff from UCSF studied pregnant women, looking for any of 163 different chemicals. She found 43 of these chemicals in virtually all 268 women in the study. So let’s take something that would harm one in a million humans. Safe enough, right? Then let’s mix it with 40 other chemicals that would each only harm one in a million. Who only knows how many people will be harmed now? What we know is that allergy rates have tripled in 20 years, that autism is on the rise as well (by 600% in just 20 years, some say), and that breast cancer, here in Marin, is higher than elsewhere in the country despite the fact that some of our risk factors are less than elsewhere. Obesity and diabetes have skyrocketed too, and though we like to assume that they are simply due to soda and fast food, that’s really naïve, in my opinion. It just so happens that many chemicals we have been living with, from phthalates to pesticides, are hormone disruptors. They are likely to be disrupting hormones like insulin or thyroid hormone.
Here’s the positive side of this observation: each toxin you remove has a huge impact, because you remove the effect of the toxin, as well as the interactions with all the other chemicals. So obviously you won’t be changing your whole life overnight, but each change you make has a much greater impact than you think.
Obviously we are still here, and most of us function relatively well, so it’s not too late. Here’s a little more about our detoxification system:
Our system is made up of two major steps: Phase I and Phase II. They are sort of like two wash cycles – first you have to go through Phase I, then Phase II. But they have to be in balance. The worst thing of all is to have substances stuck in-between the two phases. Supporting Phase II is the most important strategy, and we’ll get into how you do that.
There are also other systems involved in dealing with toxins. One interesting one involves the bacteria that normally live in our intestine. As you know, we need a healthy population of gut bacteria. The “good” bacteria actually do some detoxification – they break down some of the toxins. The “bad” bacteria, do the opposite – they can take toxins away from glutathione, and send them back into the body. So another way to be an efficient detoxifier is to make sure you have a lot of healthy bacteria in your intestine.
WHAT YOU CAN DO WITH FOOD
There’s a whole separate presentation we will be putting together concerning toxins in food: pesticides, food additives, flavorings, colorings, genetically modified foods, irradiated foods, problems introduced by cooking techniques, and so on…
But we already discussed some bad news with the water. So I would like to focus instead on what food to include in the diet, instead of giving you another list of headaches.
The general guideline is this: the body has two modes, really. One mode is rest and relaxation, the anabolic state; the other is fright or flight, known as the catabolic state. In fright mode, the body needs quick energy. It does not bother with non-emergency functions. For example, it does not bother to repair damage, or detoxify. The opposite functions, building muscle, repairing organs, feeling happy, and detoxification belong in the relaxation mode. Ideal parenting is also best done in relaxation mode – building connection, responding instead of reacting to events. So as you will see, the 10 habits of the master detoxifier are basically the activities that put the body in the relaxation mode:
10 HABITS OF THE MASTER DETOXIFIER
- Avoid toxins – You get to choose where to focus: this presentation focuses on filtering water, but the others will continue to help you transform your immediate environment: perhaps organic food, pesticide-free home and garden, safer consumer items, etc…
- Exercise – works on many levels to return the body to an anabolic state
- Stress reduction, lots of it – most powerful technique is deep breathing: five deep belly breaths lasting 5 seconds, repeat 5 times per day. Yoga, dancing, friends, singing, hobbies, journaling, meditation, prayer, psychotherapy, support groups. Building community is huge here, as well as finding something that keeps you engaged – the sort of work volunteers do at groups like MOMAS provides that outlet for us.
- Stress avoidance – this becomes a way of life; opting out of the rat race; considering stress in making decisions, doing less; simplicity parenting
- Foods that encourage Phase II; one or two daily for everyone; more if you are working to overcome health issues. See list below.
- Fiber – crucial for binding toxins, and for feeding healthy bacteria; this means plants.
- More foods that encourage healthy bacteria – yogurt with probiotics, fermented foods; pu-er tea. Raw milk and cheese also contain probiotics (not recommended in pregnancy, though).
- Diet low in sugar, white flour, processed foods – the effects of a bad diet are multiple. Basically it results in a fright mode, or catabolic state.
- Diet low in foods that encourage inflammation; There’s a bit of a controversy here between Weston-Price and the Mediterranean diet. They do both agree on a few foods to absolutely avoid: corn oil, soybean oil, factory meats including fish.
- Whatever it takes to keep the body’s elimination going smoothly: 8 glasses of water, regular bowel movements, sweating.
The food list: Garlic, onions, rosemary, green tea, flaxseed, turmeric, berries, cruciferous vegetables (especially broccoli sprouts and watercress), folate and B vitamins, chlorella. Eggs are an important source of sulfur for supporting Phase II.
In my picky family, this means I serve 1-3 foods from this list every day. I sneak them in to other foods if I need to. Smoothies and burgers are places where I do a lot of sneaking in. For myself, I have about 3-5 foods from this list every day. I sneak in onions and garlic in most meals and green tea and flaxseed in smoothies.
Supplements, maybe. If any, then probiotics perhaps are at the top of the list, or maybe eating fermented foods like kefir and kim chee is enough. I think a good multivitamin is also important, though what is meant by “good” will be open to debate.
PUTTING IT ALL TOGETHER
We are faced with choices when it comes to living with toxins in the modern world. The first choice is to ignore the situation. For some of us, this is impossible. We are already dealing with learning differences, or immune symptoms.
Another choice is to become mindful of the consumer choices we make every day. This is for each of us to decide, knowing that the choices we make sometimes even impact each other’s environment. Most likely you won’t change your life overnight, but keep at it.
Some of us have chosen to become activists, to help the government with its mandate to protect us. When we are successful at getting BPA out of baby bottles, or lead out of toys, it is a sweet feeling of accomplishment.
Another choice is to become empowered in taking good care of the tools our body already possesses to deal with our environment, and I hope we have given you good tips on doing that. This should be fun– celebrating delicious food, enjoying nature, having fun with friends.
Simple approaches you can take out of this talk:
- Filter the water
- Enjoy a steady diet of natural detoxifiers
- Incorporate exercise and stress reduction
- We’ll tackle more environmental toxins next month!
Here on the West Coast, we have nervously been watching the unfolding events in Japan. There is concern that radioactivity may travel across the Pacific to affect us by increasing long-term cancer rates.
Potassium iodide is thought to protect people exposed to radiation, and as a result, local and internet stores of the substance are now gone. I have been keeping track of the situation in Japan, and looking for reliable information concerning our risk here in California.
Finally today, I found a video posted March 15th by Jeffrey Moss, DDS, a man I respect highly for his intelligent, science-based and level-headed approach to health issues. Dr. Moss does sell supplements on the internet, but his presentation was focused on several articles he reviewed, and as you will see, he comes to a conclusion that does not involve potassium iodide (which he wasn't selling in the first place).
1. Potassium iodide (KI for our purposes) protects only the thyroid from the effects only of radioactive iodine. It does not protect other organs from radioactive iodine, nor does it protect at all from the effects of the other radioactive particles in fallout. Specifically, it does nothing to protect you from acute radiation poisoning (the kind that kills people within days or weeks).
2. Children under 18 years of age and the fetuses of pregnant women are at risk in the event of significant dose of radioactive iodine. Adults over age 30 are not at risk. They should not take KI. It would be a waste of a scarce resource.
3. The dose that people have been hoarding (125mg) was meant for nuclear plant workers exposed to a catastrophic situation. That dose can cause several side effects, including hyper and hypothyroidism, and a rash in about 1% of people who take it. As with any other substance, there is a risk of fatal anaphylaxis, and while this is rare, it would be sad for anyone to die from taking something that would have been useless anyways.
4. The dose of radiation at which the benefits of KI outweigh the risks is 25 rad. The level of radiation in Tokyo at this time is much, much, much lower. On the West Coast, it is nowhere near that in Tokyo because of the distance. There is no reason to take KI now (unless you are working in one of the plants, and I don't know about the population that has been ordered to stay indoors).
5. The KI dose that would likely be recommended depends on the age of the child and could be about 0.5-1mg weekly for several months. Anyways, this is only in the event of a catastrophe which has not yet occurred, and even then, may be an issue for Japan and not the US.
6. The kids who got thyroid cancer in Chernobyl were exposed to about 100 rad. They not only breathed in the radioactive iodine, but then, it fell on the grass the cows were eating. The cows then concentrated the radioactivity in their milk, which was then given to the children. Hopefully, we can be smarter this time around. KI continues to protect if taken as long as radioactive iodine is being ingested, though of course it's best not to ingest it.
7. Studies of airline pilots who are exposed to a lot of radiation (because flying in an airplane does that), show that they do get increased rates of DNA damage. This is reduced by about 35-40% in pilots who eat lots of dark green leafy vegetables and vitaminC-rich produce. In that study, there was no additional benefit from vitamins and supplements.
8. Similar advantages were noted in Hiroshima bombing survivors - cancer rates were reduced by 13% in those who ate dark green leafy vegetables daily (vs. less than once per week). One study of "oxidative stress" in X-ray technicians showed lower rates in those who took vitamin C supplements (500mg daily) and vitamin E supplements (150mg daily).
9. There is a concern that many people are iodine deficient (I'm not sure how you would reliably find out, but I'll look into it), and that this is the underlying problem with radioactive iodine damage to the thyroid. In Chernobyl, the soil was iodine deficient, so the theory goes that the children probably were deficient too (they are much more likely to be eating local food in Ukraine than we are here in the US).
10. If anything, here in the US, if the reactors in Japan melt down, there may be a time when we are asked to stay indoors for a few days. Perhaps if we are concerned, then, the thing to do is to make sure we have food, as well as necessary medications, etc... so we don't have a problem with staying indoors for a few days. A harder question is whether to buy insulating materials for those of us who have homes that are drafty and leaky.
Eat your vegies. Consider going to the market to get lots of kale, collards, spinach and chard, grown locally (more vitamins in fresher produce), organic (so you don't inadvertently overdose on something else), and vitamin C rich fruit such as oranges and strawberries.
In theory, all the other detoxifier and antioxidant foods (eggs, onions, turmeric, green tea, etc...) should be protective, but the research is definite only on the foods listed above.