A national study published in 2007 showed a surge in use of the bipolar diagnosis in children: the frequency of visits to doctors’ offices by youths 19 and younger for treatment of the condition increased from 25 per 100,000 visits in 1994-95 to 1,003 per 100,000 visits in 2002-03. I wonder what the numbers are now?
The above quote is from a story that appeared in the Boston Globe earlier this month [thanks to my friend in Boston who shared this story with me and urged me to write a commentary!]
The story, “Proposed diagnosis for bipolar disorder divides psychiatrists” by Patricia Wen, discusses issues with proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders IV (DSMIV). The psychiatric association is expected to make final decisions for its fifth revised edition to be published in May 2013.
A panel appointed by the American Psychiatric Association is urging that a new, potentially more transient and less-stigmatizing diagnosis – “disruptive mood dysregulation disorder’’ – be added to the official manual of mental illnesses, which is undergoing a sweeping revision [this new disorder would be included in the manual in addition to the existing bipolar disorder, and this is where the division is].
The new condition would apply to children who have chronic irritability, as well as recurrent temper outbursts – three or more times a week, on average – that are “grossly out of proportion’’ to the situation the child confronts.
It can be as disabling to a young child as bipolar disorder, but would probably be treated with antidepressants, not antipsychotic drugs. As adults, these children would be more likely to develop anxiety or depression, rather than bipolar disorder.
Wow! chronic irritability, recurrent temper outbursts, “grossly out of proportion’’ to the situation, likely to develop anxiety or depression as adults
This sounds a lot like a combination of poor diet/junk food and food intolerances. And it’s no surprise when you consider what diets kids are eating these days! Let’s also throw in low blood sugar for good measure – how many kids do you know who eat a good breakfast that includes protein?
Let’s first look at food quality and bipolar disorder:
In the Journal of Affective Disorders, a 2012 paper titled “Diet quality in bipolar disorder in a population-based sample of women”, found a lower risk of bipolar disorder in those eating a quality traditional foods diet. Granted, this is epidemiological evidence, but this is exactly why more research is imperative. The authors do actually state: “Longitudinal studies are warranted”.
Lead author of the above paper, Dr. Felice Jacka , is also the lead author in a 2011 PLoS One paper that found diet quality in adolescents was associated with a lower risk of mental health issues. The author stated that this “study highlights the importance of diet in adolescence and its potential role in modifying mental health over the life course”
Let’s also look at gluten and bipolar disorder:
In the journal Psychiatry Research, a 2012 paper titled “Markers of gluten sensitivity in acute mania: A longitudinal study” states that individuals “with mania had significantly increased levels of IgG antibodies to gliadin” “which is derived from the wheat protein gluten”.
When I read this section in the Boston Globe story a light bulb went off….
What is ultimately added, subtracted, or revised in the Diagnostic and Statistical Manual of Mental Disorders, first put out by the American Psychiatric Association in 1952, is loaded with practical and cultural implications.
It will help define what is considered normal behavior. It largely determines how clinicians diagnose conditions; what health insurers will pay for; what drugs are made and marketed; and what research will be funded by governments and foundations
Perhaps the division between bipolar disorder and disruptive mood dysregulation disorder is less important than my whole-hearted proposal to add gluten intolerance and celiac disease, junk food addict (and low blood sugar and a host of other nutritional factors) to the DSMIV!!!
I’m obviously saying this tongue-in-cheek but imagine a world where we:
- Do get government research funding and studies done on mental health issues related to or directly caused by gluten intolerance and a junk food diet
- Do get insurance coverage for nutrition coaching and consulting
- Do see subsidies for organic food farmers
- Do make this the first approach instead of medications…or at least use this approach in conjunction with lower doses of medications
- Do see huge improvements …leading to say a 40-fold (or more) decrease in bipolar diagnoses in children (and adults) in a less than a year!
Yes! Add these now… please! If we need research for it to become mainstream then so be it! I’m volunteering to be part of any research in these areas. It works – I already know this, as do countless of other practitioners and people who have made these changes. Just read Michael Ellsberg’s compelling bipolar story on Forbes to be inspired!
Dr Katherine Falk, MD is in private practice in New York City and is certified by the American Board of Psychiatry and Neurology. She endorsed my book The Antianxiety Food Solution and said this:
Trudy Scott is an expert on the relationship of food and mood, an often neglected area in the health of persons with mental illness. This book provides practical information, clearly presented, which I believe to be an important adjunct in the treatment of not only anxiety and depression, but also of serious mental illness.
I would like to end by saying that I have no intention of minimizing the seriousness of bipolar disorder or any mental illness, I just believe there is so much more we can do on the food-mood front!
Trudy,
I am so glad you wrote your commentary to the Globe article. You are so on target, not only with your comments but also with your work!
Although you write your list with “tongue in cheek” I propose that all of us psychotherapists, health care providers, recovered clients and their families adopt this list as a manifesto that will inspire us to help you spread the word about this vitally important issue in today’s mental health arena. Together we can manifest a new reality for future sufferers!
Thank you, Trudy, for your dedication on behalf of so many!
Barbara McCollough LICSW
Barbara
Thanks so much and yes “Together we can manifest a new reality for future sufferers!”
Trudy
I find it sad that rather than looking that the impact our food and non-nutritive choices have on our bodies (and especially our endocrine systems and neurotransmitters) there is arguing about what sort of new diagnosis to invent to cover this. I see it more as a way to try to sweep the growing numbers of mental illness related under the carpet than a way to truly try to help people.
What you do is so inspiring and your book is so informative. I can only hope that more people pay attention and look at the relationship between food and mood.
Mira
Thanks and yes I’m sure the growing numbers of mental illness related problems are just overwhelming to many. But it’s up to people like you, me and other nutrition professionals to inform and educate. The great thing is that folks are tired of the old ways and are looking for a better way so there is much hope.
Trudy
I think it was Hippocrates who said that one day we would treat all illnesses with proper food. We’re getting there, slowly, thanks to people like you, Trudy.
Yes, Sue, Hippocrates said “Let medicine be thy food, and food be thy medicine.” He was certainly wiser than some of us! But we are getting there and I’m on a mission to help us get back to where we should be.
Trudy
Love this Trudy! Thanks so much for the post and the comments!
My history includes early education in child psychiatry and working at Belmont Hills Hospital in the bay area in the early 90’s. It was then the first locked, acute care, psych hospital for latency aged children (not just adolescents so it was cutting edge back then). This is where I first saw the mood and food connection in children, while going to school to become a child psychiatrist (I thought) and working as a psychiatric counselor. These kids would eat cafeteria style, including choices like green Jello, bacon with nitrates, and drink soda or tons of juices, milk including chocolate milk, donuts for breakfast etc. Basically they picked whatever they wanted to eat as the staff watched table manners and behavior. I started to notice a correlation between 10 minutes to 3 hours after meal time and the times when these kids (not all but many) would “have episodes”. Back then they called them “acting out” “oppositional defiant disorder”, “non-compliance” and other descriptions would be charted by us with things like; ‘Patient displayed violence toward others and self after dinner”, “Patient displayed aggressive affect shortly after lunch”, “Patient was weepy and moody with non-specific reason when asked”, “Patient seemed to express depressive symptoms”, “patient ate well, and was well behaved during meal time, but was pacing, anxious and inconsolable shortly after dinner”. When asked why patient had hurt staff or another patient by throwing a chair patient stated “I couldn’t help it – I just feel so angry!” These were all typical notes and I started to see a pattern. I would mention it to the Registered Dietician especially regarding the children who seemed to eat mostly sugary foods, or subsist on a diet of 1 or 2 foods only. I was met with a blank stare from both her and most of the Psychiatrists who were not there very often by the way. The day to day staff like I was, we all noticed the correlation. Some of us were more interested than others I guess. Most were gaining experience and working on advanced degrees to be able to really help these children one day as I was.
The “Treatment” was usually “Management of Assaultive Behavior” as we were all trained to do – and is very hard to do on a tiny, scared albeit sometimes very violent child, 5 point restraints on a cot for the child, and some down time in the “the quiet room” behind the nurse’s station (basically a little cell like room with a tiny window they could not see out of) and a big shot of Haldol or whatever other drug was on order in the chart and given by the Nurse on staff.
At the time I just knew instinctively that the food (and the preservatives, chemicals, sugar etc..) was related. I was pretty convinced none of these children had a Haldol or Thorazine or any other antipsychotic medication deficiency.
I personally agree that the new DSM IV should be changed to include some of what you commented here about food and moods. I love the papers from Dr. Felice Jacka as well. I had not seen any of this. So thank you to your friend in Boston as well as all the others doing such great work in this field.
I also am not minimizing any psychiatric disorder or treatment in anyway, I just think we are ignoring “or sweeping under the rug as Mira commented above, a huge part of this puzzle
Kudos to the writers and researchers thus far!! Thank you!
Juli Keene, B.S.c, CN, Licensed Clinical Nutritionist
Redondo Beach, CA.
JuliKeeneCN@gmail.com http://www.JuliKeene.com ,
https://www.facebook.com/JuliKeeneNutritionist
Juli
Thank you so much for such a heartfelt and detailed response. Your early experiences in child psychiatry are so important for people to hear about and I commend you for sharing this. I’m so pleased you I did return to school to learn Nutrition, Biochemistry and how they related to the children’s moods, and all the wonderful work you are now doing with kids. We need more enlightened people like you! And you do need to write that book of yours!
I am so pleased we have connected here and on Facebook and I look forward to future collaborations
Trudy
PS Your comment was so long that I edited it. But I am going to take the whole thing and do a whole new blog post on it – I don’t want it lost here in the comments and what you have to share is so important!
VERY interesting, Trudy! XO, Katherine.
Trudy, Adjusting our diet is much much better than taking some lab made drugs! Yes this is important information. Mitch
You are a leader of this industry Trudy – can’t wait to spread your message with our Aussie audiences in our 100 Day Leading Ladies Program soon!
Thanks Heidi – looking forward to it too!
Trudy
Trudy,
Getting to know you over the years has been so eye opening because you are not only a fabulous person, you are also a wealth of information. Since changing my eating habits, reading your book and really “listening” to my body I have improved my health. AND, I always learn something new from you.
You are appreciated.
Write on!~
Lisa
Lisa
Thank you so much! and I am so thrilled to hear you are really “listening” to your body and improving your health! good for you! The body and mind are quite amazing when we provide the right nutrients and avoid all the junk!
Trudy
Trudy,
What brand and dose of Lithium Orotate do you recommend for young adults with major depression/bipolar II and ADD/substance abuse issues/anxiety?
Thank you!,
Karen
Hi Karen
I’d first address possible gluten sensitivities, eating real whole food, making sure quality protein is being eaten (especially at breakfast), caffeine and additives are not in the picture, the gut and digestion is good.
Then I look at supplements and start with the amino acids because you can see results so quickly (either positive or negative or none). Here is the questionnaire I use : https://www.everywomanover29.com/blog/amino-acids-mood-questionnaire-from-the-antianxiety-food-solution/
Other key nutrients for depression/bipolar II and ADD/substance abuse issues/anxiety are zinc, vitamin B6, magnesium etc. I also consider adrenal/thyroid and sex hormone balance and lifestyle factors.
And then assuming all the above has been implemented and there are still issues with mood swings, focus, addictions I’d consider 5-10mg lithium orotate at breakfast and lunch. I like Lifelink/Monolith. Designs for Health has a Lithium Synergy I’m going to be checking out. Here is some additional info on lithium: one of Jonathan Wright’s great articles http://www.tahomaclinicblog.com/lithium-the-misunderstood-mineral-part-1/
Possibly longer answer than you’re looking for but the basics come first 🙂
Trudy
Thank you so much, Trudy! You are a God-send!
Karen
Hi, Would like to raise the issue of the problem of Bipolar rapid cycling and how taking many of the neurotransmitter supports and even e.g. Vit B6, and zinc can trigger off hypomania when the condition if rapid cycling, is so brittle.
However FYI I have a gluten free diet;, fish oil and vit D with no problems and have just started on the Lithium Orotate at 2.5mg.
Keep up the great work.
Hi Marion
I am not familiar with zinc or vitamin B6 triggering hypomania so I can’t comment. I’m not sure what you mean by neurotransmitter supports? amino acids?
I do like lithium orotate for helping to keep the mood more event
Trudy
I am taking 450MG of Lithium for mood stabilization. Would you recommend taking lithium orotate as well?
Hi Janine
I’m afraid I can’t give advice like this on the blog. I suggest talking to your doctor and/or finding a functional medicine/integrative psychiatrist. Dr. Kelly Brogan and Dr. Hyla Cass are two that I recommend.
Trudy
my daughter has carpal tunnel and trigger finger. have you had any experience with this? what supplements would you
suggest?
thank you.
Hi Miss Thelma
I’d suggest having your daughter do the pyroluria questionnaire (https://www.everywomanover29.com/blog/pyroluria-questionnaire-from-the-antianxiety-food-solution/)and see how many low vitamin B6 symptoms she has. If low vitamin B6 is an issue, addressing this with 100mg vitamin B6 may help carpal tunnel (http://www.ncbi.nlm.nih.gov/pubmed/24312849) and trigger finger (http://wrightnewsletter.com/2012/10/01/relieving-trigger-finger/)
Ever since childhood I could not concentrate and focus at school.This seriously affected my grades. This continued into my working career and caused me to loose several jobs.
whilst I had periods of wellness this condition always returned to plague me. In one job as a retail manager I became driven for a six month period and the I crashed into
deep depression sleeping for 18 hours a day. prior to this crash I was stuffing my face with bread and fats. I was stressed and anxious. ten years later this happened again.
I was diagnosed with bipolar 2. Only now at the age of 58
I discovered that I have an intolerance to wheat (gluten)
after an elimination diet I feel so much better all my symptoms are gone. It is like a MIRACLE !.
MY diagnosis is nonsense.
Howard
Thank you for sharing your powerful story! I am thrilled for you!
What recommendations do you have for an adult male approaching 40, who has been highly critical of all situations, can be very controlling towards immediate family but nice towards others, likes to highly inflate self achievements among friends, likes to lie and cover up situations, and can be triggered for anger episodes easily, and when in those rage episodes can be extremely mean and abusive. Lacks empathy and insensitive. He has experiencied panic attacks in past, and has guilt due to loss of father 5 years back.
The anger episodes are very damaging for the people around him as it gets very abusive.
The person is off gluten (except for cross contamination), and seems to have the need to eat frequently (blood sugars fasting and random seems to be normal), but symtoms does not seem like its stable. Is on synthroid meds (possible filler issues).
What recommendations do you have, and what really could be the problem?
Thank you so much and much blessings for the work you do.
Monika
Monika
Gluten sensitivity can affect anger and anxiety so I would focus on gluten cross-contamination and find another thyroid medication as Synthroid does have have gluten in the filler.
I’d also have him do the amino acid questionnaire and look into low serotonin as this can cause anger, anxiety/panic attacks, and controlling behavior. Here is the questionnaire https://www.everywomanover29.com/blog/amino-acids-mood-questionnaire-from-the-antianxiety-food-solution/