Children who recently had a strep infection and then go on to suddenly develop symptoms of obsessive-compulsive disorder (OCD), Tourette’s, tics, odd behaviors, emotional instability, and other psychiatric and neurological disorders are believed to have PANDAS.
PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.
In some children, a strep infection appears to trigger an autoimmune attack against the brain, causing a sudden onset of neuropsychiatric symptoms.
PANS, or Pediatric Acute-Onset Neuropsychiatric Syndrome, is similar, except environmental factors or other infections trigger symptoms.
PANDAS/PANS isn’t believed to be fully credible by many experts or doctors, in part because it must be diagnosed by symptoms and because the supporting research hasn’t been very strong. Instead, they diagnose affected children with conditions such as OCD.
However, recent research sheds new light on the disorder and why it affects some children and not others.
PANDAS/PANS causes inflammation in an area of the brain called the basal ganglia, which helps govern emotions and motor control. When the immune system creates antibodies to the strep infection, these antibodies mistakenly attack tissue in the basal ganglia as well.
In 2018, researchers isolated cells in the basal ganglia, called cholinergic interneurons, which are affected by the immune attack. Previous research has shown these cells are depleted in Tourette’s syndrome.
These cholinergic interneurons fire less when strep antibodies attach to them, which is believed to cause the symptoms associated with PANDAS/PANS.
Normally, antibodies would not be able to cross the blood-brain barrier to cause immune attacks in the brain. However, research shows the spike in inflammatory immune cells called TH-17 from a strep infection can cause the blood-brain barrier to open up. This is commonly called leaky blood-brain barrier and can allow strep antibodies and other pathogens to enter into the brain.
It has been found that most of these TH-17 cells pool in the olfactory bulb, an area of the brain that receives signals from the nasal passages.
This creates a path through which antibodies can enter, especially with repeat strep infections.
Genetic susceptibility has also been found to be a link in PANDAS/PANS.
PANDAS diagnosis criteria
- Significant obsessions, compulsions, tics
- Abrupt onset of these symptoms or relapsing and remitting symptom severity
- Onset prior to puberty
- Association with strep infection
- Association with neuropsychiatric symptoms, including PANS symptoms
PANS diagnosis criteria:
Abrupt, dramatic onset of OCD or severely limited food intake and the addition of at least two of the following:
- Emotional swings and/or depression
- Irritability, anger, oppositional behavior
- School performance deteriorates
- Sensory or motor abnormalities
- Sleep disturbances, urinary frequency, bed wetting
Functional medicine for PANDAS/PANS
Functional medicine strategies can help reduce inflammation and autoimmune attacks in PANDAS/PANS and support immune and brain health.
Functional medicine strategies may include removing inflammatory triggers from the diet and the environment; nutritional therapies to lower inflammation and support brain health; addressing blood sugar, gut health, and toxicity; supporting neurotransmitters; and repairing mitochondrial function and the blood-brain barrier.
Quick action can improve outcome. For more information, contact my office.
Are you getting enough of this dementia-prevention nutrient on a vegan or vegetarian diet?
Eating a vegetable-based diets has loads of proven health benefits, including enriching your gut bacteria diversity, loading you up with plant vitamins and minerals, and ensuring you get plenty of fiber. However, if your plant-based diet is strictly vegan or strict vegetarian you may be missing out on this essential dementia-fighting nutrient: Choline.
Choline is only found predominantly in animal fats and is a vital brain nutrient that helps prevent dementia and Alzheimer’s.
In addition to supporting the brain — which is made of primarily fat, by the way — choline also supports healthy liver function. Good liver function is necessary to not only keep the body detoxified, but also to keep chronic inflammation in check. A choline deficiency raises the incidence of fatty liver.
Choline is also an essential part of cell membranes in the body and brain; cell membranes act as the cellular command center in directing cell function and communication.
Choline is found primarily in meats, fish, dairy, and eggs. Significantly smaller amounts are found in nuts, legumes, and cruciferous vegetables. The liver is able to manufacture a small amount, though not enough to meet the body’s needs.
Experts say that in order to meet the brain’s needs for sufficient choline, it needs to come from dietary sources rich in choline.
Most people are choline deficient
The bad news is most people aren’t getting enough choline, and some people are genetically predisposed to a deficiency. Research shows the rising popularity of vegan and vegetarian diets is raising rates of deficiency.
The recommended daily intake of choline is about 425 mg a day for women and 550 mg a day for men.
The two richest sources of choline are beef liver and egg yolk. Research has shown that people who eat eggs regularly have higher levels of choline (we can assume most people aren’t eating liver these days).
In fact, pregnant women who consume at least one egg a day are eight times more likely to meet choline intake recommendations compared to those who don’t.
Beef liver capsules can be a good source of choline if you don’t prefer to eat straight liver. Most products recommend 6 capsules a day. Look for a grass-fed source that has been tested for purity.
Choline is vital for the fetal and infant brain
The choline recommendation for pregnant and breastfeeding women is about 930 mg — choline is vital for the developing child’s brain.
Choline is vital for the adult brain
Choline is also recognized as a vital brain nutrient for the adult brain. In a study of mice bred to have Alzheimer’s like symptoms, a choline-rich diet resulted in improvements in memory and brain function in the mice and their offspring.
Choline protects the brain in several ways. First, it reduces homocysteine, an inflammatory and neurotoxic amino acid if levels are too high. High homocysteine levels are found to double the risk of Alzheimer’s disease. Choline prevents this by converting homocysteine to the helpful compound methionine.
Choline also reduces the activation of microglia, the brain’s immune cells that cause inflammation and damage to brain tissue when triggered.
Choline is an essential component of acetylcholine, a brain chemical known as the memory neurotransmitter. Sufficient acetylcholine is vital for memory and healthy brain function.
Choline also helps regulate gene expression.
Choline is just one of the many essential nutrients necessary for healthy brain function. Ask my office how we can help you support your brain health.
Positivity is good for health, but so is appropriate negativity — how to avoid “toxic positivity”
If you are working to manage your Hashimoto’s hypothyroidism or other chronic or autoimmune disorder, you may have heard a positive attitude is good for your health. And it’s true — positive thinking, gratitude, and healthy socialization have all been linked to better health outcomes. However, chasing a positive attitude can have a dark side.
It’s common to hear “just think positive,” “focus on the good,” “don’t dwell on the negative,” and so forth. But the truth is, sometimes life circumstances are awful and sometimes some people do horrible things to others.
The demand for a positive attitude when it’s not appropriate is known as toxic positivity. Avoiding or denying negative emotions only makes them bigger and more persistent — and hence more inflammatory for your system if you have an autoimmune condition such as Hashimoto’s hypothyroidism.
Also, negativity exists as a survival trait. It alerts you to danger, or if something isn’t right.
In fact, telling someone who is suffering that they just need to be positive is referred to as spiritual bypassing or gaslighting. Spiritual bypassing is an attempt to use false positivity to bypass a difficult issue, and gaslighting occurs when someone tries to make you feel like you’re crazy when you express uncomfortable thoughts or feelings.
Many autoimmune patients have felt gaslighted by doctors who insinuated they were making up their symptoms or just seeking attention.
Practice mindfulness, not just positivity
It’s normal to want to avoid negative and unpleasant emotions because they are uncomfortable and distressing. As such, we think of them as “bad.” But they are not there to be banished but rather to guide us through life and help us make decisions that protect and support us.
Instead of denying them through forced positivity or drowning them out through whatever addiction or bad habit is your go-to, psychologists say we should listen to what they reflect about a current situation.
For instance, if you’re frustrated and angry about your health, it means you care about yourself and being able to participate in life. Allowing and accepting our negative thoughts and feelings can help us understand who we are and to make good choices.
Resilience and self-care are the bedrocks of positivity
In self-help circles some tout the theory that bad things happen if you think negative thoughts, but the truth is bad things happen to everyone on a regular basis. Positivity isn’t about feeling good all the time, but rather about practicing resilience and positive self-talk in the face of adversity.
Do you practice these negative self-talk habits?
- You filter out the good parts of an experience and dwell on the bad.
- You think you are to blame for when things go wrong, or that it’s only happening to you and other people are luckier.
- You catastrophize and make problems out to be much bigger than they really are.
- You polarize things into very good or very bad and fail to see that most things in life have a grey area.
Practicing positivity through difficult situations means avoiding the temptation of despair and hopelessness and instead becoming your own cheerleader and coach.
Positivity is a practice, not a destination
Perhaps the most important thing to understand is that positivity takes ongoing practice and application. It is like playing an instrument or a sport — you have to keep up with it to be proficient.
This is the concept of neuroplasticity in how the brain works. By applying yourself regularly to the practice of positivity, you hardwire new neural pathways into your brain, which makes you more efficient at positivity over time. And if you have a chronic autoimmune condition such as Hashimoto’s hypothyroidism, every time you practice positivity you also release anti-inflammatory chemicals in your body that help tame inflammation and modulate immunity.
Try these tricks at learning how to be a more resilient, positive thinker who can also handle the negative aspects of life:
- If an area of your life is constant major stressor, whether it’s a job or relationship, start strategizing on how to change it.
- Check yourself throughout the day to see if your thoughts are negative or positive.
- Seek out humor. Laughing at life reduces its weight and lowers stress.
- Follow a healthy diet to lower inflammation. Many studies now prove what we eat affects how we feel. Eat food that feeds a good mood.
- Exercise at least 30 minutes a day. Generating feel-good endorphins through exercise beats any addictive substance or habit. It makes it easier to practice positivity and weather the storms.
- Surround yourself with positive people. Although we all have down days and need to vent, incessantly negative people can make it hard to stay positive. Seek out and cultivate friendships with other people who also practice positivity.
- Pay attention to how you frame things. We all say things that can be reframed more positively. For instance, if you make a mistake, instead of saying, “I’m such an idiot,” reframe it to something like, “Whoops, I’ll see if I can get it right next time.”
- Talk to yourself the way you would talk to someone you care about. Chances are you would never talk to someone you love the way you talk to yourself. Make self-respect and self-care a priority in your self-talk.
Some people were taught healthy positive self-talk in childhood by their parents and teachers. Others have to learn it later in life. Either way, it’s a skill that simply takes awareness and practice in order to develop the resilience to see you through the tough times of dealing with an autoimmune or chronic health disorder such as Hashimoto’s hypothyroidism.
What is MTHFR and why should you care when you have Hashimoto’s hypothyroidism or brain issues?
Have you been googling for ways to improve your hypothyroid or brain condition and come across suggestions to test MTHFR? What is MTHFR and what does it have to do with hypothyroidism or the brain? If you are one of the 60 percent of people with a genetic defect in the MTHFR gene, it could affect your ability to successfully manage Hashimoto’s hypothyroidism or brain-based symptoms.
MTHFR is the acronym for methylenetetrahydrofolate reductase, an enzyme involved in processing folate, or vitamin B9, into a usable form the body can assimilate. It’s also necessary to metabolize folic acid, a synthetic form of folate used in supplements.
Thanks to the popularity of gene testing, people can now learn whether they have a mutation in the MTHFR gene. If so, it means their methylation pathways are impacted and contributing to health challenges.
Methylation pathways govern detoxification and many important metabolic processes in the body, which makes a MTHFR defect something worth paying attention to. If you are struggling to manage your Hashimoto’s hypothyroidism or brain-based symptoms such as brain fog, fatigue, or depression, you may find the MTHFR test valuable.
Methylation is a process of adding a methyl group to a molecule. Methylation’s roles jobs include the following:
- Turning genes on and off
- Detoxifying chemicals and toxins from the body
- Building brain neurotransmitters
- Metabolizing hormones to maintain hormonal balance
- Building immune cells
- Synthesizing DNA and RNA
- Creating cellular energy
- Producing a protective coating that sheathes the nerves
- Metabolizing histamine
- Supporting eye health
- Burning fat
- Supporting liver health
Proper methylation means one can efficiently make proteins, use antioxidants, metabolize hormones, enjoy more balanced brain chemistry, detoxify toxins and heavy metals, and dampen inflammation. All of these factors are vital to managing Hashimoto’s hypothyroidism and brain-based symptoms.
However, if you’re one of the 60 percent of people with a MTHFR genetic defect, you may not be able to properly break down folate in foods or folic acid in supplements.
An inability to properly process folate can raise levels of homocysteine. Homocysteine is an amino acid in the bloodstream that can be dangerous when levels are too high. High homocysteine is linked to an elevated risk of heart disease and Alzheimer’s.
Poor methylation also impacts another vital process — the production of glutathione, the body’s main antioxidant. When we become deficient in glutathione, we lose our natural defenses and are at higher risk of developing autoimmune diseases, food sensitivities, and chemical sensitivities.
An MTHFR defect can also impair the body’s ability to synthesize important brain neurotransmitters, so that brain-based disorders may arise. An MTHFR defect has been linked to depression, anxiety, brain fog, ADHD, bipolar disorder, and even schizophrenia.
Because methylation is involved in so many important processes in the body, an MTHFR gene defect has been associated with many health conditions, including:
- Heart attack
- Venous thrombosis
- Birth defects
- Inflammatory bowel disease
- Mental and mood disorders
- Autoimmune disorders such as Hashimoto’s hypothyroidism
If you are trying to manage a condition like Hashimoto’s hypothyroidism or brain-based symptoms, it’s imperative that you be able to dampen inflammation and raise glutathione levels. An MTHFR defect can work against you.
Fortunately, it can be easy to address.
More than 50 MTHFR genetic mutations exist, but the two considered the most problematic are C677T and A1298C (written as just 677 and 1298).
Also, keep in mind gene defects don’t always become activated. If you show those genes on a test it doesn’t necessarily mean they have been expressed and are causing symptoms.
To address a MTHFR enzyme defect, support your methylation pathways with methylfolate and methylcobalamin (methyl B12). Avoid supplements with folic acid, boost your glutathione levels with high quality oral liposomal glutathione, and minimize your exposure to toxins. These are also beneficial strategies to aid in the management of Hashimoto’s hypothyroidism and brain-based symptoms.