When anyone asks me why I became a gastroenterologist, I often say it’s because when I was in medical training the GIs I knew had the best senses of humor. I mean, you can’t take things too seriously when you are talking all day about the gut and its varied and often unpleasant functions. I also went into GI because good digestive function is paramount to optimum overall body health. As film and television producer Nigel Lythgoe noted after he emigrated from the UK, “Since I’ve been in the US I’ve lost the back of my heart, 15 ft. of intestine and my marriage — and god, I miss my intestine.”
As a pediatric gastroenterologist, my practice contains patients from infancy to young adulthood. I have witnessed repeatedly across that age continuum that when intestinal health improves, other seemingly unrelated things such as behavior, development and temperament also improve.
Although my practice focuses on patients with a multitude of gastrointestinal issues like abdominal pain, poor growth, vomiting and liver disease, I have also noticed that many of my patients have mental health diagnoses like anxiety, depression, ADHD and bipolar disorder. In fact, it is well validated in the literature that anywhere from 50-90% of patients with either irritable bowel syndrome1 or the more severe inflammatory bowel disease2 can have anxiety and/or depression. There are many hypotheses that may explain the bidirectional brain-gut connection. They include genetic predisposition, central nervous system hypersensitization, unbalanced gut microbiome3, altered hypothalamic-pituitary-adrenal-axis, and psychological distress that triggers low-level gastrointestinal inflammation.4
A few months ago, because I have become increasingly concerned about the rising number of psychiatric medications I see prescribed for children, I reviewed the medication lists from the patients that I had seen the previous week. Amongst the laxatives and antacids was a list of psychiatric medications including stimulants, selective serotonin reuptake inhibitors (SSRI), alpha-agonists for sleep, norepinephrine-dopamine reuptake inhibitors (NDRI), and antipsychotics. Some of these medications were prescribed to children as young as four, and many children were on multiple classes of psychiatric medications. These medications cause side effects that impact gastrointestinal (GI) function such as weight gain and dyslipidemia (antipsychotics), nausea, vomiting and GI bleeding (SRRIs), and decreased appetite, abdominal pain and decreased growth velocity (stimulants).5 These adverse side effects can negatively impact treatment plans.
Yet I have a more personal interest in the connection between gut function and mental health issues. You see, until recently my nine-year-old son took four psychiatric medications. Even when he was a toddler I worried about his hyperactive and impulsive behavior. It was not a surprise to us that at age five, after struggling to get through the first few months of kindergarten, he was diagnosed with ADHD. His neuropsychological testing placed him below the 10th percentile for maintaining attention and inhibiting impulses, and labeled him with Disruptive Behavior Disorder, NOS and Oppositional Defiant Disorder as a rule out.
He was started on a stimulant medication and that helped him get through school. However, he soon developed concerning side effects from the stimulant therapy, including a poor appetite, slow weight gain, worsening sleep and increasing irritability. The volume and variety of healthy food he ate diminished as his appetite decreased. He also began to have intermittent rage episodes that would bring our entire family to a standstill.
His symptoms waxed and waned over the next few years and we tried a variety of other stimulants to address the side effect profile, all to no avail. His medical management soon went beyond the scope of his pediatrician and he was referred to a psychiatrist who added anxiety and possible bipolar disorder to his list of diagnoses. He was started on an SSRI and a medication for sleep and then eventually Risperidone, an atypical antipsychotic.
Placing him on those medications was heartbreaking, but we felt like there was no alternative as my son’s behavior, rapid mood changes and lack of sleep had almost paralyzed our family. As I went to pick up his new prescriptions I felt a profound sense of disempowerment and fear. I felt that I had lost control over my son’s future. It felt like a powerful force was pulling a part of my heart out of my chest and it was hard to take a deep breath. My ability to parent, to shape, to educate, to train was now dependent on a finely tuned combination of medications.
My son’s downward spiral propelled me to start a support group for families with ADHD in my local community. I had to do something positive in an otherwise depressing situation. At our first session, I did a poll to tally people’s interest in a variety of topics including medication management, parenting approaches, alternative therapy and nutrition. Nutrition gained many votes, and as the only medical professional in the group with a nutrition background I offered to give this talk. I had been counseling my patients and their families for years about the importance of healthy eating and good nutrition, and had seen the positive impact of this on their health. Invigorated with the idea that I might find something that would help my son, I completed a large literature search on the role diet and nutrients play in mental health issues.
During this search, I came across a case series from Dr. Julia Rucklidge that tested a broad-spectrum micronutrient (BSMN) formula on children with ADHD.6 The results were impressive as some patient’s symptoms of inattention and hyperactivity dropped into the non-clinical range. Like my son, many of the children in the study had combined type ADHD with a co-existing mood disorder. Remarkably, the children’s mood also seemed to improve while taking the micronutrients.
I looked up the micronutrient formula and it was called EMPowerplus Advanced and was made by a small company in Canada. I found additional articles that tested BSMNs on other mental health problems, and came across Dr. Bonnie Kaplan’s work on bipolar disorder7 and anxiety8 and Dr. James Adams’ work in autism9 (Dr Adams uses a different BSMN formula). I read Autumn Stringam’s book, A Promise of Hope, that detailed her recovery from generational bipolar disorder using the same micronutrient formula.
After months of reading and discussion, my husband and I decided to transition our son off his psychiatric medications onto the BSMNs. The company that makes EMPowerplus Advanced has a well-staffed and knowledgeable call center and a physician educator that walked us through the tapering of his prescription medications and starting the BSMNs. My son had a lot of withdrawal symptoms from his psychiatric medications, and was sick enough to miss two weeks of school. However, the difficult transition was well worth it as he is now drug free and doing better than we could have imagined.
His life (and ours) has been completely transformed. In the six months since stopping his medications, as his appetite improved, he gained eight pounds and grew three inches! He is generally happy and chatty and no longer has rage episodes. His teacher has sent home wonderful notes about his behavior and academics, and he has started to expand his social circle. He is no longer hyperactive nor inattentive and is learning techniques to handle his intense personality. We have been more able to implement positive parenting techniques as his mood and temper stabilized. Finally, we no longer feel disempowered about my son’s health and future. I can watch as self-control, empathy, kindness and executive planning functions develop with appropriate limit-setting and positive reinforcement.
When we made the transition onto BSMNs, I had no idea what a narrow escape we had made. I just had an instinctive feeling that nutrient therapy was a better treatment path. As John Maynard Keynes once said, “The difficulty lies not so much in developing new ideas, but escaping from old ones.” It was hard to believe, initially, that nutrient therapy could have that profound an impact. My son’s remarkable recovery with “just nutrients” has made me question the entire medical model behind ADHD and other neurobehavioral disorders.
Since then I have read Robert Whitaker’s book Anatomy of an Epidemic, and was shocked and sickened to learn that psychiatric medications may be contributing to our mental health epidemic. I researched in more detail the reported outcomes in the medical literature regarding ADHD, and found the NIMH-funded Multimodal Treatment Study of Children with ADHD (MTA) study. This study followed almost 600 children with ADHD over 16 years from around age 8 to 24 years of age. Children were randomized to four groups: medication management, behavioral therapy, combined medication and behavioral therapy, and routine community care.10 Even though children initially seemed to do better with medication management, by three years into the study all randomized groups were doing about the same.11 At the end of the study when the previously 8 year olds were now 24, all groups were again functioning about the same, independent of what randomized arm they started in.
Disturbingly, the young adults with persistent ADHD were doing much worse than their non-ADHD peers. They were less likely to have graduated college, were almost nine times more likely to be on disability, more likely to use marijuana, more likely to be sexually promiscuous, more likely to experience ongoing mood issues and, most shockingly, more likely to die by either homicide, suicide or motor vehicle accident.12
This data deeply saddened, shocked and angered me. It also raised a lot of questions for my critically thinking physician mind. From one perspective, you could say we just choose an alternative path to treat my son’s ADHD. But another, more deeply troubling perspective is the possibility that my son never had a disease, but rather multiple subclinical nutrient deficiencies that manifested themselves as hyperactivity, inattention and impulsivity. He was then placed on medications that led to irritability, poor sleep, decreased appetite and eventually rage episodes. It was not until his nutrients were replete and his medications discontinued that he was able to achieve normal wellness and behavior.
I have trained and worked at well-regarded academic teaching hospitals all over the United States and had never once been presented with this data or an alternative view to my son’s “disease.” It is estimated that over six million children under age 18 in the US are currently taking psychiatric medications. Millions of children and adolescents whose lives and future might be dramatically improved if they knew about research-grade nutrient therapies like BSMNs. Framed from that perspective, the scale of this problem in our society today was overwhelming — although I don’t routinely prescribe psychiatric medications, I am complicit in supporting this medical view in my practice and with my patients.
Many people question whether there is an ethical dilemma to discuss a brand name like EMPowerplus Advanced in an article like this. I would say unequivocally NO — it is a research-based therapy for mental health issues, therefore I have no ethical qualms telling readers and patients about it. I review the science (or sometimes the lack of science) behind therapy options with families frequently in my practice. Patients themselves ultimately decide what treatment path they want to go down. I agree that I am likely biased to treatment options I believe have less potential for harm and more evidence for efficacy, but that is what every practitioner weighs daily in making treatment decisions.
My view is also clearly influenced by my son’s story and newfound wellness. The bigger moral dilemma for me is: what do I do professionally with this transforming yet deeply disturbing information? I continue to work in an environment where a high percentage of my patients take psychiatric medications. What do I tell a family whose child comes to see me for belly pain and poor weight gain but also has ADHD, anxiety, a poor appetite and irritability? Do I mention there might be a better path for their child’s overall health or just focus on the belly pain? What is my moral obligation in that scenario?
So that is my dilemma now, and one I have not totally resolved. As Charles Eisenstein so eloquently describes in his book The More Beautiful World Our Hearts Know is Possible, I find myself in the ‘space between stories.’ Eisenstein writes: “The old world falls apart but the new has not yet emerged. . . . The life trajectory you had plotted out seems absurd, and you can’t imagine another one. . . . Without the mirage of order that once seemed to protect you and filter reality, you feel naked and vulnerable, but also a kind of freedom.”
- Whitehead, WE., et al., Systematic Review if the Comorbidity of IBS with other Disorders: What are the Causes and Implications? Am J Med. 1999;107:41S-50S. ↩
- Mikocka-Walus A, Knowles SR, Keefer L, Graff L. Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases. Inflamm Bowel Dis. 2016 Mar;22(3):752-62. ↩
- Rogers, GB et al., From Gut Dysbiosis to Altered Brain Function and Mental Illness: Mechanisms and Pathways. Molecular Psych. 2016:21:738-748. ↩
- Wouters, MM and Boeckzstaens GE. Is There a Causal Link between Psychological Disorder and Functional Gastrointestinal Disorders? Expert Rev. Gastroenterol. Hepatol. 2016, 10(1); 5-8. ↩
- Givens, C. Adverse Drug Reactions Associated with Antipsychotics, Antidepressants, Mood Stabilizers and Stimulants. Nurs. Clin. North America. 2016; Vol 51:309-321. ↩
- Gordon, HA., et al., Clinically Significant Symptom Reduction in Children with ADHD Treated with Micronutrients: An Open-Label Reversal Design Study. J Child Adolesc Psychopharm. 2015;25(10):783-798. ↩
- Kaplan, BJ., et al., Effective Mood Stabilization in Bipolar Disorder with a Chelated Mineral Supplement. J Clin Psych. 62(12);936-944. ↩
- Rucklidge, JJ., et al., Database analysis of Children and Adolescents with Bipolar Disorder Consuming a Micronutrient Formula. BMC Psych. 2010; Sept 28(10):74. ↩
- Adams, JB., et al., Effect of a Vitamin/Mineral Supplement on Children and Adults with Autism. BMC Peds. 2011;12(11):111. ↩
- Jensen, PS., et al., Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and Applications for Primary Care Providers. J Dev Behav Pediatr. 2001 Feb:22(1):60-73. ↩
- Jensen, PS., et al., 3-Year Follow-up of the MINH MTA Study. J Am Acad Child Adolesc Psych. 2007;46(8):989-1002. ↩
- Hechtman, L. et al., Functional Adult Outcomes 16 Years after Childhood Diagnosis of ADHD: MTA Results. J American Acad. Child Adolesc Psych. 2016;55(11):945-952. ↩
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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