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Children, Gluten, Sleep Apnea and Headaches, Oh My!

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gluten sensitivity in children
duckman76 /Dollar Photo Club

Here’s the reality of human physiology; we will NEVER understand how complicated it is.   Gluten sensitivity’s effect on the brain falls under this category.

There’s no doubt that many of us has a grasp on small amounts of how the body works, but the big picture is just too big for any one of us to understand fully.  It’s kind of like–I can drive around here in Phoenix quite well and know where I’m at or at least how to get to where I need to go.  But drop my in Dubai without a map or GPS and I’m pretty much screwed (especially since my Arabic is a little rusty…).

That’s a pretty good analogy to the human body and its complexity.  The most that any of us can hope for is a glimpse of insight into how it works and how we, as physicians, can help patients heal and live full lives.

This is one of the reasons why my passion has always been normal physiology and how the lifestyles we are SUPPOSED to be living impact that.  I figure it’s easier to match how we are designed to live then to figure out the details of that process.  Sort of like recommending more vegetables in your diet (because it’s the right thing to do) instead of understanding how glucosinolates in broccoli assist detoxification of environmental contaminants.

Just to complicate things even more, every system in the human body communicates and interacts with every other system.  The connections between the gut and the brain are particularly strong.  This is why treatment for any “brain disorder” should always include a look at the gut.

While this relationship may seem a little strange at first glance, the reality is that the gut is considered the body’s “second brain” since its production of neurotransmitters is as heavy as the brain.  As an example, 2/3 of the body’s serotonin is produced in the gut NOT the brain.

To further complicate matters, your DNA codes for about 25,000 different genes that make all kinds of different proteins to make sure your body is working the way it is supposed to.  Just in case that sounds a little overwhelming, the bacteria in your gut, collectively, have about 3 MILLION genes, all equally capable of making proteins that effect your health and risk of disease.

With this as a background, we can now look at just how absolutely jaw-dropping amazing this particular study is.  It brings together so many of these concepts that it is going to make your head spin.  In this small study, researchers looked at 19 children who had newly diagnosed celiac disease confirmed through an intestinal biopsy and followed them for 6 months while on a gluten free diet.

In these children with gluten sensitivity, there were some disturbing findings:

  • 37% of the children had headaches that affected daily activities.
  • 32% demonstrated symptoms of obstructive sleep apnea.
  • 48% of the children had abnormalities on EEG (a test using electrodes to check brain activity).

These findings clearly indicate that gluten (essentially a gastrointestinal condition) was having very definite negative effects on the brain.  And make no mistake–these are serious conditions to be found in children.

Luckily, the researchers then found some amazing things that were affected by 6 months of a gluten free diet:

  • The headaches disappeared in 72% of children.
  • EEG abnormalities disappeared in 78% of the children.
  • ALL children no longer had symptoms of obstructive sleep apnea.

As I mentioned, this is a small study.  However, it does link to and support other studies that have found an increase in migraine headache in those with gluten sensitivity, which gives it more weight.  While many have called the gluten free diet a “fad” I think these naysayers have managed to miss much of the medical literature linking gluten with a long list of health problems.

Even better, this is a DIETARY change with no real downside or side effects.  It is an approach that truly gets to the root of the problem rather than just glazing over the symptoms with dangerous medications with a long list of side effects.

Also, while this study only evaluated biopsy-confirmed celiac disease, which is at the far end of the spectrum, you can bet that lesser degrees of sensitivity will also link to neurological damage.  It will just be more subtle.

 

Allergies and Asthma: Dogs, Bacteria and Dust, Oh My!

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probiotics, dogs and allergies
Probiotics and pets help fight off allergies

The first 2 years of your child’s immune system are the most critical. Breast feeding, pets in the home, antibiotics, vaccinations–all these play a roll in the rest of your little one’s life.

Let me amend that–the prior 9 months before the two years start are equally as important.

Either way, the immune system does not come fully programmed; rather, it needs to be tamed by teaching it to attack what it is supposed to attack and recognize as friends our own tissues. The gut plays a large role in this process since 2/3 of immune cells interact with the gut at some point in their life cycles.

This is why having the right bacteria is so critical as is avoiding antibiotics unless absolutely critical. Antibiotics decimate the bacteria in our guts that can take years to re-balance.

As an animal lover, currently housing a near-zoo consisting of a salt water tank, three small fish tanks, 5 dogs, 3 lizards and a bearded dragon (which is actually a lizard as well but seems unique enough to warrant it’s own category), I think that having pets for children is a good idea anyway and teaches many lessons in life. Beyond that, there has been research supporting the fact that when children are exposed to animals at a very young age (that “under 2” thing again) the risks of developing asthma and allergies is lower.

This falls under the “hygiene hypothesis,” where our increasingly sterile lifestyles are not training our immune system for challenges. This lack of training leads to the development of immune system disorders. With this in mind, I think the way this particular article brings all of this together is just short of awesome.

Keeping in mind that this was a mouse study, there is no reason to doubt that the same pathway works in us. Here’s how it goes:

  1. Dogs carry dust into the household.
  2. This dust then has an effect on the bacteria in the gut, increasing levels Lactobacillus johnsonii, which has been shown to tone down allergic inflammation in the airways.
  3. This results in reduced Th2 cytokine production, fewer activated T cells.

Wow. Talk about a convoluted web! Either way, this study really strongly reinforces the hygiene hypothesis, showing that it requires dirt, dogs AND bacteria for the full beneficial effect.

 

Long term consumption of probiotic milk on infections in children – (06-07-01)

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Long term consumption of probiotic milk on infections in children

Always good to follow up an editorial with a good research article. I would of course rather see the dairy avoided altogether, but adding probiotics does provide a route of administration for children. The benefits and safety of probiotics continue to be documented, and yet these little buggers are rarely heard of in mainstream medicine. Such an incredibly powerful tool that is not being used…

bmj.com Abstracts: Hatakka et al. 322 (7298): 1327

Read entire article here

Children, behavioural problems and lead – (10-01-01)

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Children, behavioral problems and lead

This article finds an association with lead and behavioral problems in children. Once again we see a link between environmental factors and psychological health in children, and yet the concept of making changes in the child’s environment as a portion of therapy is foreign to many clinicians. Avoiding processed foods with no intake of preservatives, artificial coloring or flavors is a key to beginning to address these problems. The child with ADD does not have a Ritalin deficiency–they have a biochemical imbalance somewhere that may be able to be fixed with non-pharmacological means.

eADC — Abstracts: Lewendon et al. 85 (4): 286

Read entire article here

 

HAS YOUR CHILD HAD ANTIBIOTICS?

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Despite public opinion, the vast majority of infections will go away on their own.  Somewhere along the way we developed the misconception that our bodies are unable to deal with an infection without antibiotics.  With very few exceptions, this is very far from the truth.

I can almost hear the tremble of fear when parents talk about the notorious Strep infection.  Many would probably not even be able to tell you why Strep can be so dangerous.  The irrational fear is that Strep can cause rheumatic fever and heart valve damage, and so must be treated with antibiotics immediately.  However, the current belief is that the development of rheumatic fever is not directly related to the bacteria itself, but rather a cross-reactivity by the immune system.  Further, up to 1/3 of rheumatic fever patients had no noticeable infection prior to its development.

So what does this mean?  Certainly rheumatic fever can be life-threatening.  However, it is rarely seen in developed countries.  In addition, studies have shown that antibiotics will reduce the progression to rheumatic fever by a paltry 1.67%.  Hardly seems in congruence with the nationwide fear of Strep infections.  Overall, it seems like, if a Strep infection is going to progress to rheumatic fever, the odds are that it’s going to and there may be little we can do to stop it.

 And why the diatribe anyway?  Because antibiotic use is massively inappropriate and, despite researchers literally screaming to cut back on antibiotic use in our kids, nothing has changed.  Prescriptions for antibiotics are still prescribed in 21% of pediatric visits, and the bulk of these were inappropriately prescribed.

So what’s the big deal?  So what if a few extra prescriptions for useless antibiotics get thrown around?

I have said before that I believe that the indiscriminate destruction of healthy, protective bacterial flora in the gastrointestinal system by wanton antibiotic use is one of the worst things we can do to a developing infant, toddler or child.  The list of problems is endless and ranges from allergies and asthma to obesity to autoimmune diseases that can rip apart the gut later in life.

This particular article looks at the prevalence of the superbug MRSA in those who have been prescribed antibiotics.  At the crazy far end of the spectrum, with greater than 4 courses of antibiotics in the prior 5 months, the risk of developing MRSA was 1800 times higher.  And in any child who’s had that many courses of antibiotics in 5 months, there are serious health problems, on top of which a MRSA infection would be a very, very bad thing.

Bottom line is that antibiotics should always be an absolute last line of defense.  Any courses of antibiotics should ALWAYS be following with probiotics.  And we should do everything possible to keep the immune systems of our little ones functioning at the optimal levels with good quality foods and lifestyles.

YOUR KIDS GET VITAMIN D…BUT ARE YOU ADDING THIS?

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I’m not going to drill the point home about taking vitamin D and how we should also be sharing this vitamin with our kids. If you haven’t picked this little gem up yet, you’re obviously not going to. But did you know that vitamin D plays very closely with another vitamin?

Both vitamin D and vitamin A are needed to bind together on the nuclear receptors of our cells’ DNA. Without enough of one or the other we may experience a relative deficiency. This is why combining supplementation of vitamin D with vitamin A is a very good idea, although not normally recommended.

One of the strong benefits of vitamin A is on immune function, and studies have clearly shown that supplementation can improve immune status, especially in children, and usually in third world countries. This article takes this much further and looks at the risk of morbidity and mortality and vitamin A supplementation.

They found an overall reduction of about 25% in a child’s risk of dying from any cause with vitamin A supplementation. This is far superior to what most vaccines deliver, and indeed, the risk of measles deaths also went down in the studies.

Interestingly, the researchers looked at how the supplementation was given. Either a single dose of 100,000 IU for (ages 6-11 months) / 200,000 IU (1-5 years), doses given every 4-6 months, or smaller more frequent doses.

They were all effective, but there was some indication that the more frequent doses may have been more protective. Based on this, it would seem that giving vitamin A along with the vitamin D you and your family are already taking is a smart idea. In line with this study, a dosage of around 10,000 IU would be recommended.

THESE 2 COMMON CHILDHOOD SURGERIES INCREASE RISK OF DEATH YEARS LATER

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Were do I even begin on this one? There is no doubt that far too many surgeries done in today’s day and age are done without using appropriate conservative methods first. Far more are done without thought to the long term ramifications produced by the removal or alteration of our bodies.

The examples are endless. Overuse of orthopedic surgeries when conservative management such as chiropractic care are well documented to drastically lower the need for surgery. Surgery to remove the gallbladder has been shown to be largely unnecessary in upwards of 70% of cases. Long term outcomes of back surgery may be no better than conservative care. Removal of the gallbladder increases the risk of chronic diarrhea, colorectal cancer and fat soluble vitamin deficiencies.

And this study? Removal of the tonsils and / or removal of the appendix before the age of 20 leads to an increased risk of total mortality, cardiovascular death.  And these events were occuring very young–up to 43 years of age.

While the risk increase in relative percentage was large, the absolute risk was not that great because the risk of these events in this younger population overall is low, it is still an increased risk for surgical procedures that have other alternatives.

For the tonsillectomies, the restoration of healthy bacteria in the back of the throat using probiotics, the avoidance of antibiotics, gargling during flare ups with salt water and avoidance of foods known to thicken up the mucous in the throat (such as dairy) can go a long way towards making sure infections do not recur.

Appendicitis does carry a rather heavy risk of death if it ruptures, so this is not the time to think non-surgical. However, long before an acute episode there is disruption of the normal flora in the gut through stress, antibiotic use and a typical Western diet low in soluble and insoluble fiber. With these approaches, the risk of appendicitis will be lower.

Overall, though, this again suggests that alterations in both the way our immune system works (both organs play a role in immune function) as well as the balance of good bacteria in our bodies (both surgeries were likely preceded and followed up by antibiotic use) play a role in inflammation and our subsequent risk of chronic disease.

Bottom line, especially for our children, is to avoid these procedures at all costs and make sure that they have been exposed to healthy bacteria to help them reduce their risk of infections in the first place.

http://eurheartj.oxfordjournals.org/content/early/2011/05/27/eurheartj.ehr137.abstract

MONKEY EAT, MONKEY DO?

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It has become very clear that our children’s collective health is deteriorating.  Obesity, diabetes, liver problems and medication use are at levels that shock me.  I personally cannot understand the use of cholesterol lowering meds given to children by a pediatrician.  How do you give a drug to a population at incredibly low risk of a heart attack (the process of destroying our vascular health is a decades-long endeavor and medications that are taken 20 or 30 years before an “event” will never have the benefits outweigh the risks) in lieu of lifestyle changes?

But those changes HAVE to begin with the parents.  These kids pick up their bad behaviors from their parents.  Keegan, who is now 5, eats wild caught salmon, artichokes, olives, hummus and squash because he loves to steal them from my plate.  It’s all he’s seen and he thoroughly enjoys these foods.  The first time I heard him order a 1/2 water, 1/2 lemonade (which was our concession to allowing him something different to drink when we go out) I was pleasantly floored.  I had been quietly ordering this for months, but he had picked up on my queues.

Here we have yet another study that supports the fact that parents are not choosing the right lifestyles for themselves.  I know that parenthood can be challenging.  But that is NEVER an excuse to pull through the fast food drive thru instead of spending a little more time getting healthier fare for your children.  Our society is paying the prices for these choices.

http://pediatrics.aappublications.org/cgi/content/abstract/127/5/881