My Notes From The Children’s and Teen Health Summit
Pam Machemehl Helmly CN
A balanced brain makes for a balanced child.
I spent a long time in a compounding pharmacy, I was watching patients coming in failing medication therapy and also the little children younger and younger over my eight years there, getting stimulant medications at younger and younger ages. As they grew we saw them go on antidepressants as well as the stimulants and often times antipsychotics and I know they weren’t psychotic those babies I saw didn’t have any kind of psychosis, they were using it to move the brain chemicals around and I thought we have to do a better job.
We forgot that synthetic medications redistribute the neurotransmitters or the brain chemicals that you already have, you can’t get fresh neuro-chemicals from a drug. In some cases a combination is what’s best for the patient’s outcome, I’m not completely anti drug however I do believe that we should do everything naturally that we can then only supplement and medicate when we have to. That’s my goal finding the proper balance for these kids.
The biggest problem we have with children is GI distress, when the gut is the second brain it causes a lot of problems we make 95% of our serotonin there. Serotonin is the major calming neurotransmitter for the brain. It’s problematic because it helps us respond to stressors properly so if we don’t have enough loud noises would be a problem and properly responding to stress. You think a child is difficult and it may be a matter of balance in the gut.
Neurotransmitters are the brain chemicals that help your body do everything it needs to do from picking up a piece of paper on the floor to communicating with your organs, when they need to release something whether it’s stomach gas or to release a hormone. These brain chemicals are really important if the brain is not functioning properly it’s really hard for all those things to work properly. Sometimes amino acids work as neurotransmitters and sometimes proteins in your diet have to be synthesized to make neurotransmitters. If you eat nuts, seeds, beans, muscle meats, fish, turkey, beef, any of these they break down into amino acids. For the rest of your life from the time you are born the only way to make neurotransmitters are from the proteins in your diet so variety is important.
When you look at neurotransmitters they break down into two categories inhibitory and excitatory, inhibitory are the calming neurotransmitters that help us sleep and control aggression. The excitatory help us respond to stress and they help us to focus so there is a real balance, we should have significantly more inhibitory than excitatory ones. The inhibitory include serotonin we talked about and GABA is the super calm one, with the excitatory we have a lot more so we have to keep them in the proper range. We have dopamine for focus, noradrenaline and adrenaline, those are excreted from the adrenals the stress organs that sit on top of the kidneys. Glutamate is the most excitatory and the most damaging one and histamine. There are more but these are the main ones that we can impact with diet and supplementation if needed.
If serotonin is low the things that you see are sleep cycle issues, serotonin converts to melatonin and that helps a number of pathways to regulate our sleep cycle. Serotonin is supposed to be one and a half times more than our dopamine excretion but we make dopamine really easy from protein in our diet. A lot of times what happens if serotonin is low dopamine will over excrete and we can’t put dopamine on a serotonin receptor it’s like a lock and key mechanism. Then we start to see focus issues and short term memory issues, it doesn’t mean they have ADD they have ADD like symptoms.
Until you have a healthy body you can’t make a determination on a ADD diagnosis, we have a lot of folks coming through on medications and ultimately the goal of many parents is to reduce or eliminate. You have to heal the gut because you have histamine and a problematic gut pushing dopamine out, everyone is going to have a focus issue. It’s like when you have a cold you have mental fogginess. There are markers you can test for to see if you have a gene for this but just because you have the gene it doesn’t mean they are being expressed. With the dopamine it could be excreting too high or the syntheses is low meaning inefficient, there are multiple issues. Focus is secondary to sleep as far as complicated. We can also have low epinephrine that comes from the adrenals that could be low and a focus issue or inadequate glutamate. So if you go to a doctor asking for help and they give you a stimulant, that didn’t work lets try this one and give you a norepinephrine medication, let’s try another one. The brain is something we treat without looking at it kind of like treating your blood looking at the levels, it’s scary.
A test can be done at any time, you just want it to be done at a stable time not one in the middle of a lot of excitement. We notice that during the summer the children’s excitatory neurotransmitters subsides, we give stress a bad name but there is good stress and bad stress all related to the excitatory neurotransmitters and the way that our brain handles it is how many inhibitories do you have.
If you have looked at the health of the gut, identified problems like dairy and took that out, bowels appear to be normal meaning they are going every single day, and fluids are good, protein content is good, after that if they are still having difficulty or if their needing to take a medication for an imbalance that would be an indication to test for ADD. Maybe their not keeping up with their peers or growing normally these are other indicators for whether you want to test.
Big occurrences like divorce, surgery or death can cause a big dumping of neurotransmitters. If a child has a diagnosis of ADD, ADHD or anything on the spectrum disorders is a wonderful reason to test because you can catch things early on if you can quantify. I had a two year old that was on a fast track for Asperger’s when she was tested her histamine was six times higher than normal. If we have a very unhealthy gut and we create a leaky gut the child is going to be incredibly symptomatic. The only thing the parent brought them in to test for was the child was waking up frequently during the night. You have to think of this as balance if you have neurotransmitters like histamine and dopamine that are causing all these problems in the two year old they don’t become symptomatic until they run out of enough serotonin and GABA to maintain that sleep cycle. We become symptomatic when the amount of neurotransmitters that we got in utero and we used them up because we can’t keep up with the demand from our dietary proteins alone.
We need to do what we can to make sure your children are healthy and we don’t do enough blood or GI testing on children. Statistics just came out that up to 82% of collage students are using stimulant medications, this is very sad and unnecessary. It starts effecting personality when you start effecting neurotransmitters in a manner like that with the equivalent sometimes of having 20-25 cups of coffee at once it changes the personality of the person. You have to wonder sometimes how much of the person is personality or imbalance.
We have so many more stressors than our forefathers did, I see every child with a hand held electronic devise and this changes brain chemistry causing us to excrete dopamine that it becomes very addictive. The enjoyment they used to get playing a video for 20-30 minutes now takes 1-1/2 hours. We don’t see children playing outside that would really help with neurotransmitters, everything is quite organized. We see a different brain chemistry in our European and South American counterparts because of our stress levels here.
Secondary to the GI issues that can cause that imbalance between serotonin and dopamine we also see that both inhibitory neurotransmitters will come across low in the kids who are nervous or OCD tendencies requiring everything being just so and needing details of the family schedule, inflexible with their eating and don’t like a lot of change. When you lose ground on both the inhibitory transmitters you start seeing symptoms that are too mature for a child that age, that’s a great time to test. SSRI medications that work on serotonin are the most commonly prescribed, we are cautious about doing that with children it’s such an easy thing to put in an amino acid to help manufacture more or to heal the gut if that’s part of the problem.
With teens they will start to take control of their surroundings and their diet will change, they will start eating things away from all those healthy things that parents implemented at home may begin to negatively effect the gut and then the brain. We see a lot of females cutting back on calories and an increase of eating disorders in males as well. It’s never too early to think about are we working on an eating disorder, it’s very important to speak to someone if you think that’s coming into play.
Teens are very stressed and into many activities, clubs and sports and if their not eating enough good proteins and healthy foods with their busy schedules they come home starving and what makes them feel better the quickest is a carbohydrate and the opposite of what they need. It’s all very much a symphony all working together, you can have a balanced brain and still have a psychological imbalance. A family that eats and exercises together has a lot better chance than where the parents are busy and the kids are eating fast food. The children’s stress isn’t really kept in check, it’s tricky when parents are busy. Sleep cycle disturbances are profound in the teen population we see that their circadian rhythm does change, they will start working to stay up later on week nights then their getting up earlier because some have pre school activities. They think they can catch up on the weekend but it’s not the same you don’t want to be sixteen on the outside and twenty five on the inside because of your stress level.
If you think about the way the brain handles stress we call it the HPA access that is telling our adrenals that we have a fight or flight response, this is a problem for all of society. Our forefathers had short bursts of stress but now we have stress that’s unending. The brain is telling the adrenals we need help here sending out the excitatory neurotransmitters, we have a battle on our hands and it’s chronic. When the brain is telling the adrenals there is a problem we send out two very excitatory neurotransmitters from the medulla in the very center and then the brain is sending out as much GABA and serotonin to reign in those excitatory excesses. It’s like were chasing our tail we are causing excitatory transmitters, adults are looking for that afternoon sugar or coffee to make it to five and what were supposed to be doing is napping. We are supposed to get up when the sun comes up, go to work and when the sun is high have lunch take a nap, go back to work and bed when the sun goes down. We don’t do this anymore now there is a big pressure to push, push, push.
Teenagers today are having coffee, soda or a stimulant in the morning to try to focus and go to school. They leave the home early, have lunch at noon there’s about four to five hours without food and now they have after school sports and may or may not have a snack. They may have had just another coke or chips from a vending machine then their supposed to go and perform then come home have diner and do all their homework, that’s stress.
When I visited my daughter in Spain her little boy walked to school at 9am came home for an hour and a half lunch, walked back to school came home at four o’clock and a big dinner at eight or nine very relaxed coming and going I thought wow they know how to live. I don’t know what happened to us here, most places in the world don’t live like we do in North America.
Unfortunately our adrenals have not evolved those little stress organs are the size of walnuts and with the amount of stress we have they would need to be bowling ball size. One child that the parent brought to me because even in the middle of diner the child had to run to the bathroom, we discovered he had a severe milk allergy even when we took the milk out of the diet we had a brain imbalance he presented with all kinds of focus issues. A lot of parents because of marketing that says milk does a body good unfortunately it’s a really big molecule and one that many of us are sensitive to. We found that after the milk was removed he didn’t have to run to the bathroom anymore after every meal but the focus issue remained. When we tested the neurotransmitters we found that because he had this long term GI distress, he was eight years old, he did have a neurotransmitter imbalance he had used up his neurotransmitters, he was using them up faster than he would replace them in the dietary proteins. We balanced his brain and only had to test twice, my goal is to reduce and eliminate we don’t want them on years of supplements. Sometimes there are genetic issues that require a little more or maybe they have a little more stress than the average child.
Children who come here from other countries in cases like adoption have the gut flora of the country and diet they came from. They come here to American food and develop terrible gut issues even causing PTSD. We are lucky we now know how to test for this with a simple urine test to see where those imbalances lie. We have helped 39,000 international adoptees.
Parents will come in with food allergy tests that the pediatrician did and say their not allergic to anything but we see a histamine that’s two to three times normal. Total SigA (saliva test for anti-milk, soy, egg, gliadin antibodies) is a marker in the gut that tells you how the immune system and the GI tract is doing. It’s so important because 70% of our immune system is in the GI tract. If you have a low SigA your ability to produce antibodies, that’s what food allergy tests are looking for, if you can’t produce those it will come back as a negative. We always say make sure the GI tract is really healthy and then do the allergy testing. You don’t always have to have a high histamine because the histamine were testing is created in the GI tract it’s taking lot’s of vitamin C, vitamin C will block the excretion of histamine from the mast cells. There’s also the situation where you can’t create enough histamine just like you can’t create enough antibodies when the GI tract is unhealthy.
Depending on the size of the person you can have in your GI tract up to 7,000 square feet of absorption material and be asymptomatic even though there’s a problem but you don’t suspect it. You can have a piece of protein that could take three days or longer before it’s swept out of the system because you don’t have enough fiber in the diet and that’s a problem for some people this effects the neurotransmitters. Taking out an offending food isn’t enough you still have to rebuild the system.
First thing we do when a child comes in is look at psychological problems which could be the child just doesn’t sleep properly. We do a neurotransmitter test and based on the intake information, the histamine level as well as other symptoms we can determine if we need to build the gut at the same time were rebuilding neurotransmitters or if it appears to be a neurotransmitter issue only. Many people think that gluten is the problem when we have a serotonin situation they will go off gluten and still have low serotonin levels and it may be something else it’s the most linked neurotransmitter genetically for imbalances. Maybe there’s a problem with the pathway so putting more of that amino acid and the cofactors allows you to manage more so you can manufacture more, manage the storage and then allow it to be excreted properly. It’s multifaceted each person is so very different.
During the consultation we review the current diet of the child and may go ahead and remove foods that are known allergens before testing. We will restore the gut with good probiotics, enzymes and omega 3 fatty acids while we are working on the brain as well. We do have some nutrients in liquid form that absorb in the mouth. It doesn’t mean that issue can go away just because were restoring the GI tract so we will run a dual pathway. If it’s a horrendous issue when I get a child that’s on the spectrum and has diarrhea so bad their changing six to seven diapers a day we will hold the neurotransmitter panel because we have a bigger problem.
I see that it’s only 20-30% of cases that it’s not a combination and even when the GI tract is healed we often do have to support the brain as well. If after we do everything with diet and controlling stress if there is still a problem there may be we have genes at play. If we don’t get the kids balanced before they go off on their own it’s going to be tricky to get them to take bottles of pills so I like to get the body as balanced as possible you need to educate the child of why we are eating this, this is making good brain chemicals and understand why their not feeling good without the supplements. Kids will learn what makes them feel good when it comes to food.
The GI testing is done with two stool samples a couple days apart to see if they have enough enzymes or do they have any bugs in there. We don’t want to put them on a dairy free, gluten free diet when the problem is H-pylori the bug that can cause stomach ulcers. A lot of times if they have rashes in the corner of their mouth’s, around their nose, on their elbows or eczema these should be subsiding if your rebuilding the gut. Sometimes they don’t have any of those when we retest the neurotransmitters we will see that is significantly better that’s a good sign and we will see dopamine drop 100-200 points when the gut is cleaning up and that’s really important.
I love the book Grain Brain by Dr. Perlmutter his work is very impressive when it comes to Alzheimer’s, Parkinson’s, MS, ADD and ADHD he tightens up the loop for all these problems. He said we should treat these preventatively instead of waiting until they are symptomatic. There are also a lot of podcasts of him available so you can listen. We become symptomatic if unchecked, we know the people with IBS that 99.9% have low serotonin we can become very symptomatic and have more problems with response time and psycho social issues or productivity at work or school. Nothing is better than to get a panel back and tell the parent way to go this is a healthy brain and we can tell the parent they are doing very well. Then test every couple years to make sure everything is continuing to be on track.
We want to be able to respond to stressors properly and have a good sleep cycle, maintain a healthy diet that’s appropriate and an appropriate body weight for our frame. we can’t just give a person supplements and have them sit on a couch and get better. We do have a therapist to help guide the family to what works for them to succeed. The diet we recommend for the child is usually good for the health of the whole family so you don’t have to make two different meals.
Testing is important because all children will present different symptoms even if they get the same diagnosis and all have to be treated differently because of different imbalances. Sometimes our recommendation is neurological reorganization it’s a wonderful exercise based reintegration of the brain that’s not neurotransmitters based that helps with left brain right brain communication. It depends on how complicated the situation is for how long a treatment will last sometimes we uncover a GI issue that needs to heal but it doesn’t have to be issues with our most complicated patients, optimal ranges are usually met in nine to twelve months and three to six months in less complicated issues. It takes a while to manufacture neurotransmitters but you can see improvement within a few days or a week. You want to refill the coffers, the vesicles that store the neurotransmitters so that when you do start to reduce or eliminate supplementation that the same outcome is maintained. We balance the brain and now we figured out that Joey needs two hours of exercise a day to have a good sleep cycle it’s not always just the numbers it’s a combination. With elderly having trouble sleeping we ask how much are you walking around and they say they don’t move much.
Enough can’t be said for having good quality B vitamins and omega 3 fatty acids, adequate sleep, adequate balance of proteins carbohydrates and fats in the diet, adequate exercise and supplementing a little as necessary. Fitting in some exercise is really important even just walking if you walk fifteen minutes from the house you have to walk fifteen minutes back and walking thirty minutes a day helps to clean the blood. There is a lot of things we can do to ensure success that can be starting with just good food and exercise.
The omegas is how we conduct our neurotransmitters and we really need a lot of those, fast food has the wrong kind that are pre-inflammatory the fish oils are anti-inflammatory. Kids have a lot of snacks that don’t have a protein balance so all the direct sugars we know that the brain is somewhat melting from all these sugars. The brain size of an American is down about a half a pound from where it used to be because of all the bad sugars and fats so the cleaner the better. We really don’t need juice, drink water were supposed to eat the fruit but there are two or three isles of beverages in our grocery stores. Healthy water and keeping our digestion healthy and the fats are really tricky, it’s amazing they did a study on the breakdown of calorie counts and nutrition of fast food it doesn’t matter that the person making the food is adhering to that they may not be putting a quarter teaspoon of mayo on there it may be a teaspoon and a half so that’s problematic. We want to have good fats olive oil, freshly cracked walnuts, raw almonds when taken out of their natural state their just not healthy for us. Bad fat’s would be the fried stuff you get in fast food the omega sixes that are pro-inflammatory. If you have an athlete you definitely want to keep them off those bad fat’s. There are a lot of bad fats when you taste a nut and it tastes funny that nut has gone bad. I’m ok with the roasted nuts you don’t get the omega 3 benefit but you get the protein benefit. Also salad dressings you have to read the labels. I do love grapeseed oil there are good fats out there. Sometimes we do genetic testing to see what the proper ratio of fats, protein and carbohydrates are best for this child and what type of exercise is best for them. We don’t need to do a blood draw with children just a drop or two from a finger prick.
Pam Machemehl Helmly web page neurogistics
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M. Scherker medical researcher