It’s commonly thought that sleep apnea is simply a problem of obesity or structural issues that interfere with breathing. However, a commonly overlooked cause of sleep apnea in men and women is the brain. When the brain is not functioning properly, this can interfere with the body’s ability to maintain proper breathing function while asleep.

Sleep apnea and the brain in women

The brain’s influence on sleep apnea can be seen in women during perimenopause and menopause if their estrogen drops too low.

Insufficient estrogen causes the brain to fail in signaling the palate and tongue to maintain tone during sleep. The resulting lack of tone blocks the airway.

The brain-related cause of sleep apnea is different in men. In a rat study, young male rats responded to normal episodes of oxygen deprivation during sleep by automatically increasing brain activity to take deeper and more frequent breaths. However, the older male rats did not respond in the same way due, it’s theorized, to more aged brains.

Researchers observed a much different response to these normal episodes of sleep-induced oxygen deprivation in female rats. For one thing, older female rats responded much more positively to these hypoxic events than the older males.

Younger female rats had an even better response, especially during specific times in the menstrual cycle. This led scientists to believe female hormones play a role in how they respond to normal episodes of oxygen deprivation during sleep.

This theory is what leads researchers to believe estrogen deficiency contributes to sleep apnea in women during perimenopause and menopause. Estrogen influences serotonin, a brain neurotransmitter chemical that plays a role in giving the tongue and palate tone, including during sleep.

Estrogen tells the brain to breathe in women

To test the theory that the interplay between estrogen and serotonin plays a role in sleep apnea, researchers induced menopause in female rats by removing their ovaries. Sure enough, post-mortem brain biopsies showed less serotonin in the area of the brain that controls the tongue. This had made it harder for the female rats to respond to episodes of oxygen deprivation during sleep. This helps explain why sleep apnea affects more women in midlife.

Sleep apnea and the brain in men

Middle-aged men also experience higher rates of sleep apnea due to the effect of declining testosterone on the brain.

In midlife, men snore more and have more episodes where they stop breathing.

Middle-aged women, however, more commonly complain of insomnia, as well as headaches, fatigue, and irritability caused by sleep deprivation and poor sleep quality. That estrogen deficiency promotes weight gain, and restless leg syndrome only worsens the problem of sleep apnea.

Hormone status that plummets too low in midlife can be the result of chronic stress, poor diets, lack of exercise, and other standard bad habits of modern living. These are areas we can address through functional medicine.

Functional neurology and sleep apnea

Sleep apnea can also arise in relation to traumatic brain injuries, childhood brain development disorders such as autism, or other brain-related issues. In functional neurology we can identify areas of dysfunction related to sleep apnea, such as with nerves traveling from the tongue to the brain through the brainstem. Based on findings, customized rehabilitation exercises may help address problems with sleep apnea.

Functional medicine and neurology strategies can profoundly improve both brain and hormone function so you not only sleep better, but also feel and function better. Ask my office for more advice.

Recent studies have shown rice can be dangerously high in inorganic arsenic, particularly rice grown in the southern United States. This is bad news for gluten-free people who eat rice-based products — one study showed people on a gluten-free diet have twice as much arsenic in their urine compared to controls (and 70 percent more mercury).

Although guidelines exist to minimize arsenic exposure (buy rice from California, eat white rice, wash rice thoroughly before cooking, and cook rice like pasta in a ratio of about 6 to 1 water to rice), what about rice-based gluten-free foods? It’s nearly impossible to know where their rice comes from, how it’s processed, and what the arsenic levels are.

Arsenic levels in popular gluten-free foods

Until now. The Gluten-Free Watchdog has begun testing arsenic levels in popular brands of gluten-free foods, which you can view with a subscription.

Keep in mind that what is considered an acceptable amount of arsenic varies. Codex, an international collection of safety standards, proposes a maximum of 200 parts per billion in white rice. The European Union proposes 100 parts per billion.

However, arsenic expert Dr. Andrew Meharg proposes a  maximum of 50 parts per billion for children, who carry a heavier toxic body burden, and a maximum of 100 parts per billion for adults.

Arsenic levels in rice-based gluten-free foods

For results of inorganic arsenic testing on various brands of gluten-free foods that you can browse by category, visit Gluten-Free Watchdog. A paid subscription is required to access the reports. However, below are examples of arsenic level ranges in some categories of popular gluten-free foods.*

Inorganic arsenic in gluten-free breads

Inorganic arsenic in popular gluten-free breads ranged from 10 parts per billion to 40 parts per billion.

Pastas

Inorganic arsenic in popular gluten-free pastas ranged from 20 parts per billion to 150 parts.

Cereals

Inorganic arsenic in popular gluten-free cereals ranged from 70 parts per billion to 280 parts.

Miscellaneous rice products (rice bran, rice milk, rice syrup, rice cakes)

Inorganic arsenic in miscellaneous rice products ranged from 20 parts per billion to 540 parts.

Rice

Inorganic arsenic in several rice brands ranged from 80 parts per billion to 140 parts per billion. (Brown rice has more than white rice. Gluten-Free Watchdog reports a brand called Mighty Rice grown on the island of Mauritius shows very low levels of inorganic arsenic in their tests.)

Factor in frequency and amount of consumption

It’s important to understand these numbers tell us the concentration of inorganic arsenic in each product. The frequency and amount of any item eaten and whether the eater is an adult or a developing child are also very important factors in the equation. For example, at 540 parts per billion of inorganic arsenic, one rice bran product looks pretty bad. But consumed in very small quantities as brans typically are, it may not pose as much a problem, relative to the other foods listed, as it first may seem.

It would be better if rice were not high in inorganic arsenic. Thankfully groups such as Gluten Free Watchdog are around to help us reduce exposures. Also, there is a group based at Cornell University working to shift the world to a rice farming method that uses up to 50 percent less water while increasing yields, thus saving precious water while reducing the amount of arsenic in the rice produced.

*Ranges included with permission from Gluten-Free Watchdog LLC.

Humans have been fasting for millennia, either for religious or spiritual reasons or simply due to lack of food. Today, a new form of fasting called intermittent fasting is increasingly popular among those seeking it’s anti-aging and health benefits.

Intermittent fasting, or IF, makes fasting an everyday part of life versus something you do once or twice a year. Many people use it successfully for weight loss and inflammation control, as well as to improve brain function and insulin sensitivity. The promise of increased longevity is another reason people choose to fast regularly.

Different forms of intermittent fasting

Intermittent fasting can be done in a number of ways:

• 5:2 diet — In this plan you eat normally five days per week, and either fast completely, or severely restrict calories (500-600 calories) the other two days.
• Alternate day fasting — This plan includes normal eating for 24 hours and zero, or very low calories (500-600) for the next 24-hour period, alternating every other day. These 24-hour periods typically begin at dinnertime so that in any one day you may miss one or two meals, but not all three.
• 16:8 or 14:10 — Also known as the “eating window plan,” this plan has you eat during an 8- or 10-hour window and fast the remaining 16 or 14 hours of each 24-hour period. For example, you stop eating at 7 p.m and do not eat again until 14 hours later at 9 a.m. the next morning.

Intermittent fasting for weight loss

Restricting caloric intake can lead to weight loss, but intermittent fasting seems to help with weight loss in more ways than that. For one thing, studies show intermittent fasters have better insulin sensitivity and glucose regulation. Among other things, this makes a person crave less sugar and use glucose more efficiently for energy production instead of being stored as fat. Intermittent fasting also causes your body to burn more fat. Because it depletes glycogen, the storage form of glucose, your body switches over to burning stored fat for energy.

Intermittent fasting for brain function

Studies show intermittent fasting can benefit brain function and potentially even stave off Alzheimer’s disease and depression. This is likely due to better glucose and insulin control (Alzheimer’s disease is often called type 3 diabetes), as well as production of ketone bodies for fuel. Ketones provide a ready source of clean-burning fuel for the brain that leave behind fewer free radicals than glucose does. High-fat ketogenic diets have long been used to help prevent seizures.

Other benefits

Intermittent fasting has been shown in trials to reduce blood pressure, triglycerides, LDL cholesterol, and insulin-like growth factor, a hormone that is linked to cancer and diabetes. There is still much to learn about the benefits and pitfalls of intermittent fasting. Fortunately, it is an area of great scientific interest and research is happening at a rapid pace.

Intermittent fasting is not for everyone

Children and teens, pregnant women, people with eating disorders, as well as those with hypoglycemia should not fast. Also, diabetics taking insulin should only attempt this diet under supervision of a doctor.

Women often find less stringent forms of intermittent fasting are more suitable for them. For example, a woman might start by trying a 12:12 eating window plan and potentially lengthen her fasting time gradually, or not, as it suits her.

As always, it is important to understand that there is no one-size-fits-all remedy to any health concern. Contact my office to discuss if intermittent fasting might be right for you.

Skyrocketing suicide rates: Brain-based prevention tips

While death rates from cancer, heart disease and even homicide have gone down in the last 20 years, the suicide rate in the United States has risen sharply. Suicide is one of the 10 leading causes of death in the country, having jumped 80 percent between 1999 and 2014.

Economic distress, social isolation, and social media are factors that take part of the blame for skyrocketing suicide rates. While it is important to address these factors, we must also look at addressing depression, anxiety, and brain injury by improving brain health.

What does a brain need for health?

To function optimally, your brain needs fuel, stimulation, and oxygen; appropriately timed and in proper amounts. Unfortunately, our standard American diets (SAD) and sedentary lifestyles deprive the brain of these critical elements, setting the stage for dysfunction.

Brain fuel

The brain consumes about one third of the body’s energy and depends on a steady, reliable source of glucose to keep it fueled and functioning properly. Spikes and drops in blood sugar (glucose) levels sabotage brain function, often causing depression and anxiety.

Symptoms of high blood sugar levels include fatigue after meals, constant hunger and thirst, and cravings for sugary foods and drinks.

Some common low blood sugar symptoms are moodiness or lightheadedness if meals are delayed or missed, waking up at 3 or 4 a.m., and a dependence on caffeine or sugar to keep you going.

Both low and high blood sugar are commonly caused by eating too many processed carbohydrates and sugary foods. Therefore, one of the best ways to keep your brain healthy and protect against depression is to eat a healthy, whole foods diet devoid of processed carbohydrates and sweets.

Brain stimulation

A healthy brain also needs exercise. Physical activity, such as jogging or gardening, and mental activities, such as playing chess and reading, stimulate the brain to keep it active and healthy. Watching TV is not stimulating, and spending hours on social media can worsen brain function. A well stimulated brain is less likely to get depressed.

Oxygen

The fact that you are breathing is no guarantee that your brain is receiving sufficient oxygen. Oxygen enters through our lungs and is carried, attached to iron, through the bloodstream into the brain where it can be used by the brain’s cells. If you have poor circulation (symptoms can include cold hands and feet, or fungal nail infections), compromised lungs, or you are anemic, your brain may not be getting the oxygen it needs for optimal health, and depression could result.

History of brain trauma also important

Just one concussion triples the risk of suicide according to a Canadian study. This is likely due to unchecked brain inflammation, which damages brain cells, or neurons, leading to depression later on.  If you have had a brain injury in your past and suffer from depression or anxiety, it’s vital to seek functional neurology help to help improve your brain health.

Functional medicine and neurology strategies can help to minimize damage from concussions, thereby reducing the risk of future depression and suicide.

To learn more about how to support brain health, contact my office.

Gluten-free folks accustomed to eating rice-based gluten-free breads, pastas, cereals, and other substitutes may be consuming dangerously high levels of arsenic.

 In fact, a 2017 study showed people consuming rice-based products on a regular basis showed almost twice as much arsenic in their urine compared to those who did not (and 70 percent more mercury, another troublesome finding.)

Why arsenic is harmful

Arsenic is a naturally occurring heavy metal. It is the inorganic arsenic (not bound to carbon) that is toxic to humans if levels ingested are too high.   

Although inorganic arsenic occurs naturally, it also accumulates in soil and water due to pesticides and fertilizers. Because rice grows in water, it is the grain highest in arsenic.

Consistent exposure to small amounts of arsenic increases the risk of bladder, lung, and skin cancer, as well as heart disease, type 2 diabetes, and neurological disorders. Consuming arsenic during pregnancy may affect the baby’s immune system.

Consumer Reports found one serving of rice pasta, rice cereal, and rice milk exceeded a safe amount of arsenic for one week while one serving of rice cakes came close.

The FDA recently proposed a limit of 100 parts per billion of arsenic in infant rice cereal.  However, it’s impossible to know how much arsenic is safe to consume as risk is dose dependent; the more you consume the higher the risk.

How to minimize arsenic exposure from rice

These troubling truths about arsenic exposure through rice don’t have to spell doom for gluten-free folks who depend on rice-based substitutes.

For starters, look for products made from other grains besides rice. Thankfully, there are many more on the market these days.

Look at where your rice comes from. In 2014 Consumer Reports found that rice from Arkansas, Louisiana, or Texas had the highest concentrations of inorganic arsenic while California rice has almost 40 percent less arsenic. Brown basmati rice from California, India, or Pakistan has a third less inorganic arsenic than other brown rice.

Unfortunately, because the arsenic comes from the water, organic rice may not be lower in arsenic.

Consider white rice. Since arsenic tends to accumulate in the outer layers that are removed to turn brown rice into white, white rice contains less of the toxin than the whole grain.

Rinse your rice thoroughly and cook in excess water. Wash your rice thoroughly before cooking and then cook your rice in a ratio of about six cups of water to one cup of rice and drain the excess water after. This cuts down arsenic levels by about one third compared to letting rice absorb all the water during cooking.

Consider a grain-free diet. Many people feel and function significantly better on a grain-free diet. If you don’t eat rice-based products, excessive arsenic exposure is one less thing to worry about in a world where we are constantly at battle with toxic chemicals and heavy metals.

Ask my office for more ways to protect yourself from toxic chemicals and heavy metals.

Although genetics play a role in memory loss, that doesn’t mean you have to be a helpless victim to the ravages of brain degeneration. By taking action right away if you notice memory loss, you can reverse your risk of dementia and Alzheimer’s before it’s too late.

One study showed that nine out of 10 patients were able to reverse their memory loss. The study subjects also showed significant long-term improvement in memory function.

What was the magic bullet? No magic, just implementation of functional neurology basics.

The subjects underwent a dietary and lifestyle overhaul that included changes in what they ate, regular exercise, supplementation, better sleep, and exercising their brain.

The improvements were so profound that some of the subjects were able to work again, having previously quit their jobs due to advancing memory loss.

Of the 10 study subjects, the only one not to improve suffered from late-stage Alzheimer’s — showing how important it is to take action to reverse memory loss before it’s too late.

Although plenty of functional neurology clinical cases show memory loss can be reversed, this was the first study of its kind.

Functional neurology to reverse memory loss

In the study, subjects reversed their memory loss through the following approaches also commonly used in functional neurology:

• Removing all simple carbohydrates (white rice, pasta, bread, sugar, etc.) from the diet
• Eliminating processed foods
• Gluten-free diet
• Eating more produce and wild fish
• Doing yoga and activities that reduce stress
• Increasing sleep from 4-5 hours a night to 7-8
• Supplementing with methyl B12, vitamin D3, fish oil, CoQ10, curcumin, resveratrol, ashwagandha, and coconut oil
• Exercising a minimum of 30 minutes four to six times a week
• No snacking
• Use of hormone therapy in cases where it was necessary

Researchers found the biggest challenge in the study was complaining from the subjects about all the changes. Nevertheless, all but one enjoyed significant benefits.

How functional neurology can reverse memory loss

One of the more important factors in reversing memory loss is reducing consumption of simple and processed carbohydrates. These foods spike the blood sugar, inflame the brain, and trigger a cascade of chronic health problems.

In fact, some researchers call Alzheimer’s type 3 diabetes because excess sugar and carbohydrates are so destructive to the brain.

Exercise is another vital strategy to reverse memory loss because it has so many beneficial effects on the brain.

It’s also important to get enough sleep every night to reverse memory loss. This is because one purpose of the brain waves produced during sleep is to transfer memories from short-term storage to long-term storage areas of the brain (hippocampus to neocortex). Too little sleep disrupts this process.

A gluten-free diet can be a profound tool to reverse memory loss — in some people gluten triggers inflammation or autoimmune destruction of brain tissue, sabotaging memory function. Other foods such as dairy, eggs, soy, and grains can do the same.

Although most people think a gluten sensitivity causes gut problems, the truth is that it more commonly causes neurological damage. For some people, simply going gluten free profoundly improves their brain health and reverses memory loss.

Rehabilitating brain deficits to reverse memory loss

In addition to dietary and lifestyle approaches, functional neurology rehabilitation techniques can help reverse memory loss. If an area of your brain is under active or over active, functional neurology exercises to restore balance and function to the brain will help improve overall brain function, including reversing memory loss. 

Ask my office about ways functional medicine and functional neurology can help you reverse memory loss and prevent dementia or Alzheimer’s.

We commonly think of autism spectrum disorders (ASD) affecting mostly boys. While it’s true ASD affects more boys than girls, it turns out that many girls go undiagnosed because their symptoms are much different than that of boys. Girls with autism may behave socially more like neurotypical (aka, normal) males than boys with autism. Female autism may also be misdiagnosed as anorexia, obsessive compulsive disorder (OCD), or attention-deficit/hyperactivity disorder (ADHD).

The diagnostic criteria for autism — difficulties with socialization and communication and repetitive, inflexible behavior patterns — come from studies on boys. A 2012 study of 15,000 twins found that girls needed to exhibit more extreme behavioral problems and intellectual disability to receive a diagnosis. This means that many girls on the milder side of the ASD spectrum go undiagnosed.

Girls with autism closer to typical boys

Brain scans, genetic testing, and other measures show that girls with autism disorders not only present differently than boys, but also that the understanding of autism has been overly narrow by primarily studying boys.

For one thing, brain scans show a girl with autism processes social information much differently than neurotypical girls, but also differently than boys with autism. Instead, their brain operates very much like that of a neurotypical boy. Furthermore, research assessing friendship quality and empathy showed autistic girls score about the same as neurotypical boys.

Girls are better able to hide autism

Girls often go undiagnosed also because they can excel at suppressing their symptoms and studying and mimicking neurotypical girls. However, it’s an exhausting and stressful process for autistic girls, who show a much greater desire to connect than boys.

Girls also exhibit less repetitive behavior and more typical types of play as children, although researchers can pick out subtle differences — obsessively lining up their Barbies, for instance, or being more engaged in staging a scene than the story line.

Female autism can present as anorexia or OCD

Autistic girls also differ from their neurotypical peers by being extreme in their traits, such as “too sensitive” or “too intense.” Their single-minded intensity is believed to underlie anorexia in some who channel those traits into dieting and body obsession. The extreme aversion to certain tastes and textures common with autism also lends itself to anorexia. It’s estimated about 20 percent of women with anorexia also have autism.

The same can be said for autism and OCD, as obsessive-compulsive behavior, fear of change, and being overly rigid are hallmark traits of both OCD and autism.

Autism can make girls vulnerable to predators

Sadly, the autistic girl’s traits of taking things literally combined with social isolation makes her more vulnerable to sexual predators and abusive relationships.

Autistic girls are more apt to suffer from anxiety, low self-esteem, social isolation, and depression. Although people with mild autism are ten times more likely to be suicidal than the general population, the rate is highest in women — 71 percent of women with Asperger’s report suicidal thoughts.

The role of maternal testosterone in autism risk

Autism risk is linked with higher levels of fetal testosterone. A mother with polycystic ovary syndrome, a hormonal disorder that causes high testosterone, has an almost 60 percent higher risk of giving birth to a child with autism. This is why having a female brain offers protective barriers to this tendency.

However, researchers have found girls with autism have a higher number of genetic mutations than autistic boys. In other words, a girl’s brain may need more genetic and environmental “hits” in order to develop autism. 

Although the autoimmune diet is a well known foundation for managing chronic health issues, some people are dismayed to find embarking on it makes them feel worse. What gives? The sudden change in diet can temporarily upset your chemistry and reveal hidden health problems.

If you have been accustomed to eating gluten, dairy, grains, sugars, and processed foods, going cold turkey off those foods is a radical shift. Likewise, adding in lots of vegetables can also shock a digestive system unaccustomed to ample plant fiber.

Most people feel significantly better on the autoimmune diet. If you’re not one of them, however, don’t give up on the diet. Instead, look for the underlying reason why.

Feeling temporarily worse on the AIP diet

Following are common adverse reactions to the autoimmune diet. Knowing why you react negatively can further help you on your wellness journey.

Low blood sugar. Symptoms of low blood sugar and adrenal fatigue can worsen on this diet. This is usually caused by not eating enough or frequently enough. The general recommendation is to eat every two to three hours, however, some people may initially need a bite or two every hour until blood sugar stabilizes and they can go longer without eating. Avoid sugary fruits and investigate what else may be taxing your adrenal function, such as brain-based issues, autoimmunity, or chronic infection.

New food sensitivities. When gut damage is bad and inflammation high, it’s possible to develop food sensitivities to new foods on the autoimmune diet. This is very frustrating for people as the diet is already so limited. This can be a complex situation that requires concerted effort to tame inflammation and repair the gut.

Opioid withdrawal reactions. Opioids are morphine-like chemicals made by the body that reduce pain and create a feeling of euphoria and well-being. Some people become dependent on foods that release opioids in the brain, namely gluten and dairy. They can initially experience depression, anger, lethargy, and agitation on the autoimmune diet. For those with serious opioid addictions to gluten and dairy, withdrawal can be intense.

Brain chemical imbalance. A diet high in processed carbohydrates affects brain chemicals that influence our mood, particularly serotonin and dopamine. Suddenly switching to a lower carbohydrate diet can disrupt the balance of brain chemicals and cause temporary changes in mood, behavior, and personality. If this sounds familiar, you may need to gradually lower carbohydrate consumption.

Insomnia and anxiety. Some people report irresolvable insomnia and anxiety if carbohydrate consumption is too low. If these symptoms persist long after an adjustment period, you may simply need to use trial and error to find the carbohydrate “sweet spot” that lets you sleep but also keeps blood sugar in check.

Difficulty digesting fiber. The autoimmune diet is heavy on vegetables. For those with compromised digestive function, this can overwhelm the gut. Concerted gut repair nutritional therapy can ease you into a higher fiber diet.

Histamine intolerance. This is a reaction to aged or fermented foods that causes myriad symptoms, including rashes, runny nose, or headaches. Avoiding these foods for a while can help the gut heal so you can eat them later.

Yeast and bacteria die-off reactions. Going cold turkey off processed carbs, gluten, and dairy can cause a sudden and uncomfortable die off of harmful yeast and bacteria in your gut. This is especially true in the case of poor liver detoxification and constipation. Supporting the body’s pathways of elimination can help.

These are a few of the issues that can arise when you switch to the autoimmune diet. Don’t forget to consider the grief and anger you may feel about missing your favorite foods. However, if you weather the transition and ferret out sources of discomfort, your newfound health will more than make up for the rough legs of the journey.

Hypothyroidism has received a lot of attention online since the publication of Why Do I Still Have Thyroid Symptoms? by Datis Kharrazian in 2009. While many facets should be addressed in managing hypothyroidism, one of the most important continues to be a gluten-free diet.

Research shows ninety percent of hypothyroidism cases are due to an autoimmune disease that attacks and destroys the thyroid gland. This disease is called Hashimoto’s.

Most doctors do not test for Hashimoto’s because it does not change treatment, which is thyroid medication. Also, many cases of hypothyroidism go undiagnosed because Hashimoto’s can cause the lab marker TSH to fluctuate.

Where does gluten fit in with this? Numerous studies have linked an immune reaction to gluten with Hashimoto’s hypothyroidism. Whether it’s a gluten sensitivity or celiac disease, gluten triggers an autoimmune attack on the thyroid gland in many people. Most of these people do not even know they are sensitive to gluten.

Going off gluten is the first step with Hashimoto’s

Studies, clinical observation, and patient stories make a very strong case for the benefits of going gluten-free to better manage your Hashimoto’s hypothyroidism symptoms.

A number of studies from several countries show a link between Hashimoto’s and gluten. This is because the protein structure of gluten closely resembles that of thyroid tissue. When your immune system reacts to gluten, it may start erroneously reacting to thyroid tissue as well. This will cause the immune system to attack and destroy thyroid tissue in a case of mistaken identity.

Studies also show patients improve on a strict gluten-free diet. One study showed as many as 71 percent of subjects resolved their hypothyroid symptoms after following a strict gluten-free diet for one year.

Why you may need to stop eating other foods too

Sorry to say, going gluten-free alone doesn’t always work. Many people with Hashimoto’s hypothyroidism also need to go dairy-free. Dairy, whether it’s cow, goat, or sheep, is the second biggest problem food for people with Hashimoto’s hypothyroidism.

Many people simply have an immune intolerance to dairy and aren’t aware of it until they stop consuming it. However, in an immune sensitive individual, the body may also mistake dairy for gluten and trigger an immune reaction that ultimately ends up targeting the thyroid.

For those serious about managing their Hashimoto’s hypothyroidism, a gluten-free and dairy-free diet frequently results in profound alleviation of symptoms, if not total remission.

Many find they may need to eliminate additional foods, such as certain grains, eggs, or soy. An elimination/provocation diet can help you figure out what your immune system reacts to, or a comprehensive food sensitivity test is another option.

What is there left to eat?

If you’re used to eating without restrictions, eliminating gluten, dairy, and possibly other foods to manage your Hashimoto’s hypothyroid symptoms may seem overwhelming and too restrictive. Many people are left wondering, what is left to eat?

Rest assured there is more than enough to eat. Most people fare well on a paleo diet that is primarily vegetables (a diverse array of plenty of vegetables helps create the healthy gut bacteria that improve immunity.)

More importantly, symptoms and general health improves so dramatically that people come to love their new diet and despise the way they feel after they cheat.

Ask my office for more information about implementing a gluten- and dairy-free diet.

If a child suddenly develops behavioral and neurological symptoms after a strep infection, PANDAS should be suspected. PANDAS is a neuro-immune disorder in which a strep infection triggers brain inflammation and the immune system starts to attack and destroy brain tissue, causing a sudden onset of neurological symptoms.

PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.

PANS, or Pediatric Acute-Onset Neuropsychiatric Syndrome, is similar, except environmental factors or other infections trigger symptoms.

PANDAS diagnosis criteria

• Significant obsessions, compulsions, tics
• Abrupt onset of 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:

• Anxiety
• Emotional swings and/or depression
• Irritability, anger, oppositional behavior
• Regression
• School performance deteriorates
• Sensory or motor abnormalities
• Sleep disturbances, urinary frequency, bed wetting

Functional neurology help for PANDAS/PANS

Because PANDAS and PANS involve the immune system, management involves testing markers for inflammation, infections, immune function, and brain autoimmunity (when the immune system attacks and destroys brain tissue).

It’s also helpful to conduct a functional neurology exam to identify compromised areas of the brain, as well as to establish a baseline of brain function.

Repeat testing can show you how well PANDAS/PANS protocols are working. Functional neurology rehabilitation may also help with recovery. For instance, therapies targeting different areas of the brain can calm an over active immune system and over activation of pathways.

Functional medicine help for PANDAS/PANS

Additionally, 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.

Conventional medical help for PANDAS/PANS

Therapies from the conventional model that have been shown to help include steroids and NSAIDs for inflammation; plasmapharesis (plasma exchange) to reduce antibodies; intravenous immunoglobulins (IVIG) to support immune modulation; and immune modulating medications when necessary.

Understanding the PANDAS/PANS brain

When PANDAS/PANS strikes a child — an estimated 1 in 200 children are affected — parents become both frightened and devastated. Understanding what is happening in the brain can help alleviate anxiety.

The functional neurology exam can help identify which pathways in the brain are affected. PANDAS/PANS typically affects communication loops between the basal ganglia, cerebellum, and frontal lobe.

Act quickly to address PANDAS/PANS

PANDAS/PANS is a significant and scary disorder, but taking action quickly improves the chances of an optimal outcome. For more information, contact my office.