Ritalin risks in kids; functional neurology alternatives

New research shows the use of methylphenidate, also known as Ritalin, prior to the maturation of the brain around age 23 can lead to long-term changes in how the brain functions.

Methylphenidate appears to cause permanent alterations in how GABA, the neurotransmitter responsible for calming the brain, functions in the medial prefrontal cortex. This area of the brain plays a role in memory, decision making, socialization, and behavior.

The study did not find the same changes in patients who used methylphenidate after age 23 and whose brains were no longer developing.

As ADHD rates soar, so do drug prescriptions

Symptoms of ADHD include inattention, impulsivity, and over activity to a degree that interferes with learning and relationships.

Rates of ADHD, or attention deficit hyperactivity disorder, have been soaring in recent years in the United States. ADHD diagnoses increased by 43 percent between 2003 and 2011.

About 11 percent of American children have been diagnosed with ADHD. As rates go up, so do prescriptions for methylphenidate — about eight out of 10 doctor visits for ADHD result in a prescription for Ritalin or similar drug (Adderall, Focalin).

Functional neurology perspective on ADHD

Although most doctors’ visits only last about 10 minutes and concerns about over diagnosing and over prescribing are legitimate, it’s also true rates of childhood brain disorders in general have been exploding during the last decade.

Children with ADHD also frequently have problems with anxiety, mood disorders, emotional disturbances, sleep difficulties, motor coordination, learning disabilities, food sensitivities, and digestion.

In functional neurology and functional medicine, we see ADHD as something more complex than a need for a drug prescription. Studies show the brain disorder is linked to a variety of possible causes.

For instance, environmental toxins, viral or bacterial infection, and autoimmune attacks (when the immune system attacks and destroys tissue) in the brain that began in utero or in infancy have been linked to ADHD and other childhood brain development disorders.

These factors interrupt the normal development of the brain and the child may skip developmental milestones, such as crawling. This then leads to imbalanced development of the right and left hemispheres, the neural networks, and communication between the brain’s hemispheres.

This explains why children typically have various brain-based symptoms in addition to ADHD, such as tics, anxiety, obsessive-compulsive tendencies, sleep disorders, and so on. Although drugs such as methylphenidate may offer relief, they do not address the underlying cause of ADHD.

How functional neurology addresses ADHD

In functional neurology, we begin with the brain’s metabolic health. This includes diet, food sensitivities, blood sugar, gut health, inflammation, gut health, infections, and autoimmunity.

We use exams and patient history to assess areas of the brain that are under and over developed, and areas that are over stimulated or under stimulated.

From there, we then create custom exercises to rehabilitate the brain and adjust them over time as function improves.

Ask my office how functional neurology can help if your child with ADHD.

Concussions and whiplash can damage the inner ear

Although most people worry about skull fractures and brain damage when they sustain a head injury, the inner ear, or vestibular system, may also become damaged and cause long-term problems if neglected.

Vestibular injuries cause problems with balance and dizziness, as well as anxiety and moodiness.

The vestibular system, a labyrinth of semi-circular canals, perceives motion in three-dimensional space and is known as the equilibrium center. It works with the eyes and the brain to let you know where you are in the environment. It is vital to safety, survival, and attention.

One way to think of the vestibular system is to imagine holding a glass of water while driving. When you turn, accelerate, decelerate, or stop, the water moves in opposition to the movement. Your vestibular system, which contains fluid and sensory hair cells, works in a similar manner, sending signals to your brain to keep your body stable and aware as you move throughout your daily life or in sports.

Vestibular injury in concussion and whiplash

Studies show vestibular injury is common with concussions and whiplash. Even when there are no signs of brain injury after an accident, about 16 percent of people will have vestibular injury.

Vestibular injury can come from a fracture to the skull in the area surrounding the inner ear. Or it can come from damage to the nerves in the brainstem that communicate with the inner ear.

Distinguishing vestibular injury from brain injury

Functional neurology offers specific exams that distinguish vestibular injury from brain injury.

A test using videonystagmography is one of the most commonly used in functional neurology. This involves the patient wearing infrared goggles that capture eye movements on video the practitioner can view on a computer screen. The patient’s eyes are monitored in both light and darkness and through various ranges of motion, such as turning or nodding the head and spinning in a chair.

Using the analogy of glass of water while driving, the eyes reflect what is happening in the inner ear in response to movements. This can show in what ways vestibular function is impaired, and whether the damage is structural or due to damaged nerves in the brainstem that feed information to the inner ear.

Targeting inner ear injury determines treatment

The distinction between inner ear injury and brain injury is vital because it determines the course of treatment. Many brain injury victims are put through the same course of rehabilitation despite the nature of the injury in the hopes that the rehab will hit some of the pertinent areas in need. This can be inefficient.

However, using functional neurology to target the specific areas of impairment to both the brain and the vestibular system (or just the vestibular system) can make for much more effective rehab strategies.

Vestibular system treatments

Because the inner ear is connected to vision and movement, therapy that combines specific eye exercises with certain movements can improve function in damaged areas of the inner ear. For instance, the patient may spin to the right in a swivel chair while watching lines move upward on an iPad.

This is a much different approach to a brain-specific exercise, which might include balance and coordination exercises.

Ask my office for more information about how a vestibular system injury or disorder might be affecting you.

Rates of mental disorders in children exploding

It’s estimated one in five children in the United States has a mental disorder these days, and the rate is rising at an alarming degree. This means as many as 12 million children are currently affected.

What does a childhood mental disorder look like? It can affect a child’s behavior, learning ability, and their ability to handle their emotions. It can also mean more significant diagnoses such as bipolar disorder, autism spectrum disorders, and conduct disorders.

It’s tempting to want to pin the rise on one factor, but studies shows links between childhood brain disorders and autoimmune disease during pregnancy, environmental chemicals, and industrialization of food.

These are all factors that have been shown to profoundly impact the developing brain in utero and in childhood at an alarmingly increasing rate.

One study demonstrated the rate of hospital stays among children for mood disorders increased 80 percent since 1997. Additionally, pediatric admissions for mental health issues — such as depression, bipolar disorder, and psychosis — and substance abuse issues increased 24 percent in just three years prior to 2010. Nearly one in ten hospitalized children have a primary diagnosis of a mental health disorder.

About 11 percent of children had been diagnosed with attention-deficit/hyperactivity disorder (ADHD) by 2014.

Other common diagnoses include autism, anxiety, depression, Tourette’s syndrome, behavioral disorders, and alcohol and substance abuse.

Autism linked to maternal autoimmune disease

Researchers have linked childhood autism with autoimmunity in the mother during pregnancy.

The brain of the fetus is already developing in the the first trimester and is profoundly affected by the mother’s immune status.

An unmanaged autoimmune condition in a pregnant woman, such as Hashimoto’s hypothyroidism, type 1 diabetes, rheumatoid arthritis, vitiligo, etc., points to a hyper zealous and imbalanced immune system.

Some of these mothers also have an undiagnosed (and often asymptomatic or mildly symptomatic) autoimmune reaction to their own brains that they pass on to the child via immune antibodies.

These antibodies damage the brain of the fetus. This sets the stage for autism or the triggering of autism by a factor in the environment, such as chemicals or heavy metals.

Women with autoimmune disease are more likely to carry these immune antibodies to the brain.

Children with mental disorders also frequently demonstrate other signs of immune imbalance and autoimmunity, such as food intolerances, gut problems, asthma, eczema, and yeast infections.

A parent can lower a child’s risk of brain disorders by screening for and managing their own undiagnosed autoimmunity and inflammation prior to conceiving.

For instance, rates of autism are higher in children whose mothers lived near freeways during pregnancy due to increased pollution.

Managing your immune system through functional medicine and functional neurology, eating an anti-inflammatory whole foods diet, cutting out common dietary immune triggers (gluten and dairy are the most common), and avoiding toxins as much as possible are examples of strategies to improve the odds of giving birth to a child with a healthy brain.

For more information about how to manage autoimmunity, contact my office.

The neuroscience of why diets make you fatter

Many studies over many years show diets have steadily made Americans fatter. Why does dieting cause obesity? Blame the brain and its influence on emotional, hormonal, and neurochemical responses to dieting, deprivation, satiety, and shame.

Dieting is rarely effective, it doesn’t improve health, and it does more harm than good. Studies show regardless of the diet you follow, from vegan to paleo, you’re battling ancient neurological survival mechanisms that typically win out in the end. The brain is essentially wired to fight weight loss.

An obese man has a one in 1300 chance of reaching normal weight within a year and an obese woman has a one in 700 chance, and the majority of both these groups will gain back the weight in five years.

In fact, weight loss statistics show only about one percent of dieters keep the weight off permanently! What’s worse, almost half of dieters will gain back more weight than where they started.

Even just one diet can make you fatter: Research shows a single diet makes a man twice as likely and a woman three times as likely to become overweight.

And two or more diets? For women, that makes them five times more likely to become overweight.

Teenage girls who diet repeatedly are four times more likely to become overweight compared to their non-dieting peers, and 12 times more likely to binge.

Athleteswho compete in sports that require them to lose weight, such as boxing or wrestling, are three times more likely to be obese later in life.

Why the brain hates dieting

It’s important to understand the neurology behind deprivation, weight loss, and weight-related anxiety to appreciate why diets fail so many people.

In essence, the brain hates famines and is programmed to keep you at a steady weight based on your genetics and life experiences.

Dropping below the set point can cause a person to burn fewer calories, trigger the release of hunger hormones, and increase activity of brain chemicals such as dopamine that increase cravings for food.

Studies of both humans and rodents show binge eating is a normal mammalian response to food deprivation due to the effect of deprivation on brain chemicals that govern the response to rewards. They also show stress promotes cravings for sweeter, fattier foods.

Also, replacing the brain’s natural cues around hunger and satiety with the rules and regulations of dieting overrides its ability to regulate weight.

Just thinking you’re fat makes you fatter

Studies show just thinking you are fat will actually lead to increased weight gain, whereas teen girls who underwent a program to fight eating disorders stabilized their weight while the girls who didn’t do the program gained weight.

What to do when dieting has made you fatter?

The best choice to avoid weight gain is not to diet. However, most people — primarily women — have been on many diets by adulthood or midlife.

Research shows that as long as a heavier person exercises regularly, eats a healthy diet with lots of vegetables, and avoids risky behaviors such as smoking or isolation, their health outcomes are on par with a thin person’s who leads the same lifestyle.

Good brain health depends not on how fat or thin you are, but instead on healthy gut bacteria, positive stimulation, low exposure to sugars and processed starches (high blood sugar is very damaging to the brain), plenty of oxygen, reduced inflammation, and other basic healthy lifestyle factors. In fact, stressing about your weight and dieting is bad for the brain — stress is a notorious cause of accelerated brain aging.

Many people are pleasantly surprised to find that by letting go of weight loss and instead learning to love a healthy diet and lifestyle, the unwanted pounds melt away. But if they don’t, you can still be healthy and active. Ask my office for more advice on taking care of your brain health.