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| ARTICLES: CHILDHOOD ANXIETY DISORDERS: NATURAL AND NUTRITIONAL APPROACHES | ||
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JULY 2011 - Childhood Anxiety Disorders: Natural and Nutritional Approaches
Twenty five percent of 13-18 year old children in the US have had an anxiety disorder, serious enough to be diagnosed and require intervention. Anxiety is even more common in kids with Asperger’s syndrome and autism. No steadfast rule places anxiety disorders in the purview of teens – even toddlers can have anxiety serious enough to obstruct socialization, learning, sleep, and development. There are several types of anxiety disorders, from obsessive compulsive disorder to panic disorder. Many parents, teachers, and even doctors cluck at the very idea of anxiety in children. How bad can it be, really? If you haven’t experienced life with a child who has a true anxiety disorder, it’s hard to imagine how debilitating this is. From being unable to participate in normal activities, to being blamed for creating it, anxiety disorders isolate and traumatize children who experience them along with their families. When my own child exhibited an anxious, avoidant demeanor before he was a year old, it was confounding and frustrating for our whole family. His anxiety was poorly tolerated by most our friends and even his young peers – who fell away one by one – and by family members too. Happy events like birthday parties and holiday gatherings, group picnics at parks or playgrounds, or usually fun spaces like a children’s museum or school zoo field trip became white-knuckle, tension-drenched agonies. His anxiety would escalate to panic and bolting, or even seizures. More than once at family gatherings, he endangered himself: Fearing the host’s large dog at a Thanksgiving celebration (which the family refused to partition) he once secretly retreated to a frozen attic space, where he remained in his shirt sleeves for nearly an hour before found. From climbing into a car trunk (I found him just as he was shutting himself in; he figured out how to open the trunk on the dashboard), to wandering outdoors in frigid weather, my son endangered himself on many occasions to quell anxiety. With his safety and wellbeing at stake, we were forced to withdraw. Our world became smaller and smaller, after it was clear that only a few family members and friends were willing to welcome us on terms my son could manage. School environments were rife with anxiety triggers in his case as well, making each year a new challenge. A top developmental pediatrician suggested an SSRI for him when he was barely three years old. We deferred, not having any idea what the long-term effects may be (that was in 1999, and these are still unstudied). We later tried a slew of psychiatric medications, which either triggered heavy side effects, or produced lackluster progress. Do kids outgrow this stuff? Maybe, but that has not been true in my son’s case. A neonatal vaccine injury may have triggered damage to structures and pathways in his brain responsible for calming chemistry. For many youngsters I meet in my nutrition care practice, challenges like these have persisted with age, rather than faded. I meet the kids who have not succeeded with prescription medications, have not outgrown anxiety experienced since early childhood, or are so young that parents do not wish to medicate them. What are the options? There are nutrition-focused options that may help. Many of these are discussed in detail in Special Needs Kids Go Pharm-Free. It’s important to get professional assessment from a pediatric mental health professional first, to discern whether your child is managing anxiety, depression, or both, before trying any nutritional or pharmaceutical intervention. Different neurotransmitter pathways may need emphasis, depending on your child’s presentation. These tips below focus on anxiety. I’ve picked these out of the many pharm-free possibilities because they have been favorite performers in my practice. For nutrition-focused tools with potential to intervene on depression, hyperactivity, focus, attention, and more, see Special Needs Kids Go Pharm Free. As always, consult your health care providers before diving in. Ask questions, seek guidance; do not take this information alone as medical advice for your child. Most of all, if your child is currently using a psychotropic medication, speak to your prescriber before using nutritional supports or making changes to the medicine. Top pick #1: Inositol Inositol is a naturally occurring molecule that is classified as a sugar-alcohol. Our bodies make a supply of it from glucose; it’s needed for many biochemical pathways and intracellular messaging systems, including those that affect mood. It’s also needed to make phospholipids, which are crucial for normal cell membrane construction – and that is crucial for normal cell function. Cell membranes gate-keep chemical messengers that go in and out; if the membrane structure is rigid or altered, messaging falters, and this can be true for the messengers that create calm chemistry. Using inositol may help cell membranes, and the chemical messenger receptors upon them, work better. Inositol is in many foods, including bananas, cantaloupe, oranges, grapefruit, and lima beans. We may normally eat about a gram of it each day. A healthy human bowel has ample bacteria in it that produce inositol too. Interestingly, kids on the autism spectrum have been found to not have the same bowel microflora profiles as typical peers. Even more interesting – something I’ve repeatedly witnessed in my practice – treating these bowel infections improved features of autism, in at least one trial. Given in multi-gram doses, inositol has performed robustly for anxiety disorders like obsessive compulsive disorder (OCD) and panic disorder, and has also done well in some trials for depression. For just one example, click here; more links are here. In my opinion, this is a stand-out option for children with anxiety disorders, OCD, and panic disorder. The trick is using the right dose, in the right form, and to move into the therapeutic range gradually. Since high doses are needed, gastrointestinal side effects like diarrhea or bloating and gas can occur at first. Avoid these by starting very low (1 gram) and going slowly up (as high as 12 grams/day in split doses, or 18 grams/day for teens at above 120 lbs). Give a high potency probiotic (20 billion CFUs or more) with each inositol dose; give with snack or food. You can also use antifungal herbsconcomitantly to help control GI symptoms and keep unwanted yeast in check during inositol usage. Give these herbs away from inositol and probiotic. Pros: Inositol is easy to use. It dissolves easily in water or juice, and has mild sweet taste. No toxicity or side effects are reported, excepting GI discomfort. Cons: May trigger GI distress if given too much too fast. Children with poorly controlled yeast or other bowel infections should treat those before using inositol. Tip: Buy only a pure inositol powder, with no fillers or other nutrients, from a reputable source, not capsules, which are inconvenient for the dosages necessary. Kirkman Labsand Solaray offer pure inositol without fillers. Be sure your child has a good multivitamin with B group in it, which will help the inositol work better. Top Pick #2: Homeopathic Aconite A pretty perennial called Buttercup is used to make this famous homeopathic remedy for panic. As is true for most homeopathic remedies, the source substance is dangerous and should not be mistakenly used for home treatments of any sort. Homeopathic Aconite is useful acutely, that is, in situations where a child is blanched and frozen with irrational and grandiose panic, particularly one that includes a fear of death. It isn’t to be used daily unless you are working with an experienced naturopathic doctor or homeopath who has instructed you to use this remedy specifically for your child. But, given a situation that needs quick intervention, I have observed it to be effective. My own child was able to return to anxiety-provoking classroom activities in elementary school with this remedy, and endure air travel better. If lactose in the pellets is verboten, obtain a tincture from a professional homeopath; begin here to locate a trained homeopath. A very low potency daily dose may be the trick for your child. Aconite is not the only homeopathic remedy a professional might pick for an anxiety disorder, but it is a standout for acute situations. Pros: Widely available, inexpensive, easy to administer Cons: Over-using any homeopathic remedy can exaggerate symptoms you are targeting for treatment. Use only for emergent symptoms; stop once symptoms improve, unless your homeopath instructs otherwise. Consult an experienced provider for more guidance. A helpful book for safe home use of homeopathic remedies is Everybody’s Guide To Homeopathic Medicines. Tip: Homeopathic remedies must be given away from foods, drinks, tooth-brushing, strong aromas, or any substances in the mouth. Top Pick #3: GABA promoters GABA is Gamma Amino Butyric Acid, one of the brain’s most prevalent neurotransmitters. Its abundance is second only to glutamate. It has an inhibitory or calming effect; it shuts down the excitatory effects of glutamate. If GABA isn’t doing its job, the flow of exitotoxic chemistry in the brain can escalate to seizures, and in fact, many seizure medications target GABA chemistry. Besides anxiety disorders, low GABA has been noted in Parkinson’s disease, addiction, cognitive impairments, bipolar disorder, depression, and headaches. Vitamin B6 (pyridoxine) is needed to make it, which is why some see improvement in seizures and anxiety with high doses of B6. We produce GABA in the brain from glutamine, a common amino acid in food. Eating GABA itself as a supplement may not work well, since it doesn’t typically cross the blood brain barrier. But GABA promoting herbs and amino acids may help raise GABA levels and lessen anxiety. Here are some possibilities that have been successful in my practice, to ease anxiety through GABA promoters: - Your child should use a high quality, high potency multivitamin and mineral supplement that supplies ample pyridoxine and /or pyridoxal-5-phosphate, as well as magnesium, some iron, and the full B vitamin group. Examples are Kirkman Labs Thera Response or Klaire Labs VitaSpectrum. - Valerian, bacopa, skullcap, ashwaganda, rhodiola, gingko biloba, and passion flower may enhance GABA activity. These may bind the same receptor site as benzodiazapene drugs. Tinctures, capsules, teas, and tablets are widely available. Consult a naturopathic doctor (ND) for correct dosing. It may be well worth the time and trouble to find a provider with naturopathic training, as these herbs can be impressively effective with little to no side effects. - Some children may be able to tolerate glutamine as a supplement, the precursor amino acid for GABA production. I have not found this to be the case in my practice. Though it is a widely touted tool for GABA promotion (and gut health), children who are challenged in converting glutamine to glutamate to GABA may experience heightened agitation, anxiety, or even seizures with glutamine supplements. Mercury disrupts this conversion, so if you have reason to suspect your child has had mercury exposures, then you may not have success with glutamine. - The amino acids taurine, alanine, and theanine may either promote GABA or oppose glutamate. Toxicity for these is low, and research on them abounds – for one example, click here. Taurine is typically started at 200mg per dose for children, and up to as high as 600mg or even 1000mg. Theanine is usually given from 50-200mg. Consult a naturopath for dosing instructions for your own child. Pros: Herbs and amino acids can be easily administered to children and safely used, with guidance from an experienced practitioner. Side effects are minimal. Cons: MDs are not trained in the use of natural tools like these, so you may need to acquaint yourself with a good naturopathic doctor (ND) specializing in pediatric or family practice to get dosing guidance. Don’t mix these with psychotropic medication, unless your provider instructs you to do so – amino acids and herbs may synergize or negate effects of some medications. Tip: Use herbs from organic sources with high standards for screening for toxins, including heavy metals. See chapter Chapter 7 of Special Needs Kids Go Pharm-Freefor more information on the quality of supplements and herbs. Top pick #4: Carnosine This is probably one of the fastest, easiest, most straightforward options to test for a child, especially if anxiety is combined with explosive behavior or rageful outbursts. Not to be confused with carnitine, the amino acid famous for body building supplements, carnosine is a di-peptide found in protein-rich animal foods like chicken, beef, or egg. It is a strong antioxidant, and may have a protective effect on receptors in the brain that impact excitotoxicity and seizures. It has been clinically reviewed for use in autism, and has shown promise in reducing social anxiety while improving cognition. Carnosine may boost GABA and is also of interest formitigating seizure activity. Carnosine is a newer amino acid tool than taurine, alanine, or theanine for quelling anxiety, so less research exists on this. A usual starting dose is 250 mg, and up to 1000mg/day. A supportive high potency multivitamin is once again a good idea, especially for zinc and vitamin E. Toxicity is very low; it leaves the body rapidly. Pros: Easy to give in capsules, which are widely available; or, open capsules to mix with food or fluids. Easy to quickly see a result; usually within a two to three days, a child will show a response once the dose is correct. Cons: Cost. Liquid carnosine is available for younger children, but more expensive. I prefer to suggest capsules for mixing in to liquids, as a budget measure. Tip: Give in the morning or after school, rather than at bedtime, to observe effects on anxiety. Top pick #5: Antifungal therapy How many hundreds of kids have I met with intestinal candidiasis, or other candida infections, that went unnoticed – from within ears and sinuses, to lungs and urinary tract? Reams of websites, books, and even some peer review exist on this conundrum that general pediatric practice has yet to appreciate. Harboring excessive Candida or fungal microbes disrupts behavior, appetite, stooling, mood, focus, and attention, in my clinical experience. If your child has a history of antibiotic use – even if only briefly – consider this possibility. The nearer your child’s antibiotic exposure to birth, the more likely s/he is to harbor Candida to a disruptive degree. Treating a Candida infection with antifungal herb, medication, or high dose probiotics is another of my most favorite ways to see anxiety drop in a child. It often works. The stronger the antifungal tool, the faster it works. Using a low carb or low sugar diet will work slowly. Probiotics alone can work a little too slowly too. My preference, if a Candida overgrowth is confirmed, is to aggressively treat the child with medication (if the child’s MD will allow it) or potent antifungal herb tincture for 2-4 weeks at a minimum. I follow this with high potency mixed strain probiotic, to the tune of as much as 60-100 billion CFUs per dose, of mixed strains for Lactobacillus and Bifido species. This direct strategy may trigger die off of harbored yeast, which means a brief period of worsening behavior or anxiety; but it should pass within a week to yield a calmer, happier, and literally rosier child. My favorite over-the-counter herb tincture for this purpose is Gaia Flora Wellness drops. For knowledgeable professional input on the herb piece, contact herbalist Libby Rupp at Herbs For Autism, or speak with your naturopathic doctor. Pros: When indicated, this measure works fast (within a week or two), and may also improve many other challenges your child is probably having: Picky appetite, constipation or diarrhea, bloating, gas, acne/rashes, bedwetting, or stool accidents. Cons: May require a strong prescription like Diflucan from your doctor, if herbs and probiotics don’t do the trick. But, I have witnessed strong herb blends to work better than medication in some cases. Tip: Though this doesn’t always happen, prepare for initial die-off reaction and some bumpy days. Ease the excretion of dying yeast from the body with Epsom salts baths. If your child uses a probiotic, give this a few hours away from the antifungal herb. Find more tips and strategies in Special Needs Kids Go Pharm-Free. If your child has autism, find even more specifics on leveraging nutrition, diets, and supplements for autism spectrum disorders in Special Needs Kids Eat Right.
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