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Aphthous Ulcers/Canker Sores, Gluten Sensitivity and Unmanageable Behavior

Report from the Front: The Gluten-Celiac Question

Just in the office last week: An "acting out" child, smart, second grade, unable to respond to medications with two previous docs repeatedly adjusting meds to no avail.

She is depressed, suffering with ADD, emotionally up and down, diagnosed Bipolar, trials of atypicals [antipsychotics] and antiepileptics to no avail. - and she complained of canker sores.

This is what her mouth looked like: -and, yes, I did ask the important  *number two question* regarding bowel frequency. Her response: "Every two or three days" Canker sores are often related to Gluten Sensitivity.

Since Gluten sensitivity, and it's downstream end point, Celiac, is genetic, I asked her mother the same question. Her response: "Switches from constipation to diarrhea since childhood."

And her Grandmother had joined for the evaluation, so I asked her as well - with the response: "Irritable Bowel Syndrome my whole life."

I ordered the LRA/ELISA ACT [see the description and research here under Immune Dysfunction Testing], and will keep you posted. Initial impression: pervasive genetically related bowel disorders across the family and with our patient - likely related to an immune dysregulation - likely gluten. The GS [Gluten Sensitivity] is likely contributing to the emotional volatility. Psych meds adjusted slightly downward, as she appeared too sedated with Risperdal.

Stay tuned, I will post the results, even if I didn't get this right.

More than just Vitamin D: New Specifics On Vit D3

Vitamin D3 is more than just Vitamin D and Sunshine         
Many are recognizing the relevance of Vitamin D3 testing for multiple brain and body applications, but there are some important caveats found in this recent paper:

JJ Cannell†, BW Hollis, M Zasloff & RP Heaney, "Diagnosis and treatment of Vitamin D deficiency," Expert Opin. Pharmacother. (2008) 9(1):1-12

1. D3 is not D2, and most of the large doses written for the convenience of infrequent dosing - is D2,
2. Pay attention to the dosing based upon the levels found in testing,
3. Notice the specific test that is recommended: 25-hydroxy-vitamin D (25[OH]D), 
4. Review the multiple applications for D3 levels in a variety of conditions from osteopenia, to fibromyalgia, to depression
5. Relevance in pregnancy and breast feeding documented
6. 105 solid references with treatment specifics

We've been interested in D3 for some time now, and recommend following Dr Cannell's work at the Vitamin D Council site and through his newsletter there.

And here is an interesting article on Vitamin D and Mental Illness.

Sydney Spiesel MD: The problem with psych drugs

Report from the front:
Just back from Hartford and New Haven CT, and met several interesting physicians, one of whom you will be interested in following through the links in this post: 

Dr Sydney Spiesel, a busy practicing pediatrician [and PhD who first trained in molecular and cellular physiology with a specific interest in immunology] who regularly comments on NPR,

- is a professor at Yale Medical School,           

- regularly writes a Health and Science syndicated column at Slate,

- and on top of all those activities, provides video commentary at Dr Syd's [video] House Call.

This Spiesel link to his comments on ADD and food additives.

We enjoyed an excellent discussion of things medical, pediatric and psychiatric, and quickly arrived at our shared observation about child psych meds in general: [Paraphrased for brevity]

Psych meds are often written for children with little appreciation of the overall metabolic issues present in the child. -If we don't understand the child's ability to metabolize medications, don't look adequately for comorbid conditions which can effect metabolic rates, and don't think about drug metabolism and interactions... there will be problems.

It was great fun to meet Syd - you will enjoy his energy, his intelligence, and his balanced views on the current state of medical care.

Watching Your Brain Leave: A Neuroscientist Reports on Her Stroke

Neuroscientist Jill Bolte Taylor: On TED Talks:

Taylor "had an opportunity few brain scientists would wish for: One morning, she realized she was having a massive stroke. As it happened -- as she felt her brain functions slip away one by one, speech, movement, understanding -- she studied and remembered every moment. This is a powerful story about how our brains define us and connect us to the world and to one another."

Pop over to this link for Taylor at TED Talks for her original presentation, and to review the TED site: Technology, Entertainment and Design. Taylor discusses an interesting report on what it feels like to know brain anatomy and identify parts of brain function leaving, while it's happening.

And rest reassured, Taylor demonstrates an interesting, evocative recovery with this animated presentation.

Run time: 18.44m

Dr Russell Jaffe: Notes on Brain, Body and Foxhounds at CorePsychPodcast

Just posted last night over at CorePsychPodcast  the First in a Series [13.5m] of interesting and fun interviews with an important colleague who shares an interesting and stimulating message: Brain science and new information about molecular and cellular physiology are changing the way we practice psychiatry and medicine.

Dr Russell Jaffe joins us for the first in a series on the evolution in medicine and how paying attention to the new details can help not only with our own lives but the lives of our patients.

Good listening!

Gluten Notes: Respiration, B12, and Nutritional References

Gluten Postings

This brief note will keep you linked with more interesting information about gluten sensitivity and the medical and psychiatric implications. 97% of celiac disease remains undiagnosed and untreated... and if those are the numbers for celiac, just imagine what's going on with gluten sensitivity.

A Book Note:

Journey over to the new books at CorePsych Books listed under Metabolism and Diet. There you will find several on the new Gluten shelf including this new book: Celiac Disease a Hidden Epidemic written by Peter Green Director of the Celiac Disease Center at Columbia University.

"The true medical impact of celiac disease is just beginning to emerge. This is the first authoritative guide on how the condition is properly diagnosed, treated, and managed."

On Respiration and Gluten Sensitivity

Recently had an inquiry from an interesting reader with multiple immune dysregulations and adrenal fatigue who was wondering about difficulty catching her breath during martial arts sparring. Looks like autonomic dysregulation frequently occurs with gluten sensitivity. Take a look at this link for the many lung conditions possibly associated with gluten sensitivity.

And read on for more...