What role do healing cycles, the cell-danger response and the mitochondria play in restoring balance to children's overloaded neurological systems?
Ahead of the 2019 Mindd Forum Conference we chat to integrative paediatric clinician, Dr Elizabeth Mumper about the core pillars she employs in her own practice when working with children with neurodevelopmental disorders. She also shares what she is most excited about teaching at the forthcoming Mindd Forum and what she's looking forward to learning about from her other professional peers at the conference.
Covered in this episode
[00:38] Introducing Dr Elizabeth Mumper
[02:22] Dr Mumper's career background
[04:43] What is 'cell danger response?'
[11:46] The work of Dr Naviaux
[16:09] Mitochondria: a key to cellular healing?
[23:20] Can we assess mitochondria?
[28:15] The pillars of supporting the cell's healing cycle
[35:02] Improving parasympathetic tone
[38:49] Why magnesium is so crucial
[44:10] Histamine and Mast Cell Activation Syndrome
[47:56] Are we over-medicated?
[51:50] What will be covered at Mindd Forum 2019
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining us on the line today is Dr Elizabeth Mumper, who is president and CEO of the Rimland Center. Her general pediatrics practice is Advocates for Children. Advocates for Families is her practice devoted to the care of children with autism and other neurodevelopmental problems.
Dr Mumper graduated magna cum laude from Bridgewater College with a degree in General Science. She attended the Medical College of Virginia and was invited to serve as Chief Resident of Pediatrics at the University of Virginia. She's spent five years in practice at F. Read Hopkins Pediatrics, over a decade as director of Pediatric Education at the Lynchburg Family Practice Residency Program. Maintained a clinical faculty appointment at the University of Virginia for 16 years, and served as Medical Director for the Autism Research Institute for five years.
Dr Mumper has conducted clinical research at the Rimland Center and published five peer-reviewed articles in the medical literature. Dr Mumper is also a scientific advisory board member of the Mindd Foundation. A not-for-profit organisation helping those with conditions which often affect the mind, so all profits go back to more support and education for families.
Welcome to FX Medicine, Dr Elizabeth Mumper, how are you?
Elizabeth: I am doing great, Andrew, and I really appreciate the opportunity to talk with you all today.
Andrew: Thank you. And I got to say it's our honour for your dedication to the kids and the families, who suffer from neurodevelopmental problems. So, thank you for spending your time with us.
Elizabeth: So, that award was for Central Virginia. So I wasn't Woman of the Year for the world, but it was in recognition of my work in Virginia. I was involved in a bicycle helmet campaign many years ago. I was a teacher, who was highly ranked at the residency program where I taught, and I was doing a lot of work in the community with domestic violence and child abuse at that time.
So, I got that award just as I was getting sucked into the autism epidemic, and so it reflected some of my community work pre-autism, pre-neurodevelopmental issues, and before I had the opportunity to travel widely to talk about the medical problems of children with autism.
Andrew: Yeah. And you've also done research and written book chapters in medical texts. Tell us a little bit about that because I think this, again, is prior to your interest in autism. Is that right?
Elizabeth: Yeah, that is correct. And so I wrote a couple of book chapters that actually were quite relevant for my work with autism. One was actually on child development, and the other was on immunology.
And as we'll talk about today, the immune system is often very dysregulated in children with autism, and that was one of the first things I started noticing clinically in my practice, in children that had neurodevelopmental problems, they often seem to have food allergies and allergic rhinitis and asthma and chronic infections.
So, perhaps what I researched doing those two book chapters helped along the way to recognise these patterns that I hope clinicians will really start focusing on and looking for in this generation of children.
Andrew: Well, today we're going to be discussing healing cycles and the cell danger response, which you and Dr Robert Naviaux will be discussing at the 2019 Mindd Forum in Sydney. Let's first go into that. What is a cell danger response?
Elizabeth: Yeah, this is really elegant research that Dr Naviaux has done, and I am really hopeful that he'll get a Nobel Prize for it one day because I think it's that much of a game changer.
Andrew: Oh, wow.
Elizabeth: So it's really quite interesting. The mitochondria is, you and your audience may know, are like the powerhouses of the cell, or they're sometimes described as the battery of the cell.
Elizabeth: And so they're crucial for all kinds of function, and they're found in every cell in the body, except in red blood cells. And through a very intricate set of reactions, we take the food we eat and convert it into something called pyruvate, which is then shuttled into the mitochondria, and then it goes through a five-step process where through complex I, II, III, IV, and V, various cofactors are added such that we ultimately produce something called ATP, which is the energy currency of the cell, basically.
Elizabeth: And so in order for us to do any work biochemically, or to contract our muscles, or to beat our hearts, or to think with our brain, we have to have these mitochondria functioning well.
So, sadly, lots of different things can actually affect how well the mitochondria functions. So, for example, various viruses or other infections can impair this process. We know that heavy metals and environmental toxins can impair the process. Even minor things like the cell's a little too salty or not quite salty enough, or the pH, the acid-base level, is a little too acid, or little too basic. All those things can affect the mitochondria and we know now that even psychological traumas and traumatic situations that might lead to PTSD, have a profound effect on the mitochondria.
So what happens is that when the mitochondria get the idea that there's something threatening, that's hurting them, they go through a series of processes to sort of wall-off the castle, so to speak, and protect themselves. But they also send out these chemical messages that tell the surrounding cells that there's danger.
So some of these things are like stiffening up the membranes of the mitochondria so that, hopefully, whatever's trying to get in won't be able to penetrate. Or they will release certain chemicals into the surrounding space that will try to kill whatever the infection might be. And, interestingly, they also have effects on our behaviour because, as a part of the cell danger response, nature wants us to sort of rest and try to heal, and so it will make you want to sleep more, and it will make you want to get away from your friends and family. Because, you know, you want to try to not infect the whole tribe, so to speak.
Andrew: Yeah, yeah.
Elizabeth: And Dr Naviaux has done the seminal work on this for many years, and it has led him to write a bunch of elegant papers about, first, the cellular defence of the mitochondria. But now he's taking even a more magnificent step forward to talk about the healing cycle of the cell.
And this is where I think it's really exciting. He's looked at over a 100 conditions that are associated with this ‘cell danger response.’ And looking at how utilising the healing cycle, we might be able to intervene and treat those conditions.
So, one of the old models of medicine is, get a person's symptom, try to figure out the one thing that they have, the one disease, name the disease, and then give a drug to treat the disease.
Elizabeth: This is a totally different mindset. This is like lots of different impairments, or nutrient deficiencies, or traumas, or infections, or toxin exposures can lead us to express our cell danger in many different ways. And perhaps, and I believe this to be true, we can actually do more healing if we look at the commonalities and the fundamentals, and realise that if we can intervene to help nature heal, we wouldn't need all the medications.
So, nature has a very strong impulse toward healing. And a lot of times, what we need to do is get out of the way. So, it raises a bunch of interesting questions about what we're doing to our environment because what we do to our environment, we ultimately do to our bodies. And our bodies are trying very hard to adapt to the new normal, where, you know, food is processed and comes in packages instead of being picked off the trees or grown in the ground, and we have so much air pollution, and people are just exposed to so many chemicals that we were never really created or evolved to handle.
So, we have to figure out a way to let nature do her thing. And a simple way to look at it is after we take complex histories on patients, to try to figure out a way to see what they're getting that might be bad for their cell healing cycle, or what they need to get as a nutrient to help move that cycle forward.
So, in a nutshell, that's the constellation of what we'll be talking about in Sydney.
Andrew: So, the cell danger response, is that equivalent to ‘sickness syndrome?’ Where, you know, you get inflamed, interleukin-1 B. You know, you get the feelings of a cold, you want to retreat. You just want to rest. You want a darkened room. You want to shy away. You don't want to be partying all night. Is that the same?
Elizabeth: Yeah. I would think of it as the cell danger response leads you to do all those things that you mentioned. Yes, exactly.
Elizabeth: So he is one of these amazing people, who is extraordinarily brilliant, and yet the nicest guy you'd ever want to meet.
He has a number of clinical appointments at the University of California in San Diego, and is widely recognised as a wonderful geneticist, specifically with metabolic genetics, which has to do with various enzyme deficiencies and metabolic problems that lead people to express certain genetic syndromes.
He also is a foremost clinician and researcher in the area of mitochondrial research. And I visited his lab, and he has done a lot of elegant work on, for example, the earthworm. To help him elucidate some of the work related to mitochondrial function and the things that he can find out about how mitochondria adapt to environmental changes.
So, one of the things I love about Bob is that he can take something that's incredibly complex and use amazing analogies so that it becomes very easy to understand. So, he has gotten sucked into the autism vortex also, and has been attending the Autism Research Institute Think Tanks for a number of years. And he has done a pilot study that has shown significant reversal of so-called autistic type symptoms with a drug called suramin, which is an old medication that was used for African sleeping sickness.
Elizabeth: And he repurposed it in these children with autism, because he recognised that it worked on these very fundamental, what are called ‘purinergic signalling systems,’ and very fundamentally affected the cell danger response.
So, again, this is going very much upstream and trying to treat the root cause of these children's problems, and not just, you know, give Risperdal because their behaviour is bad, and give another medication to help them sleep at night, and another medication to help them not hit the teachers. It's so elegant to try to go back to the root causes.
So that work is going to expand into phase 2 and phase 3 trials. It's a long and frustrating process for the parents of the world who have children with autism because research done well, that's going to lead to, you know, widespread adaptation of whatever the therapy might be. You know, first you have to prove that it's safe. Then you have to prove that it's effective. Then you have to do it in a bigger crowd so that you can try to detect potential side effects that weren't seen initially, and it can be a multi-year process. But I have every faith in him that he's going to continue to pursue this work, and I can't wait to read the next paper.
Andrew: Yeah. So, suramin, how, so, works on purinergic, did you say, as in purines?
Elizabeth: Yeah, purines and pyrimidines, which are basically part of cell signalling. And Bob will do a beautiful job of explaining this in the lectures that he gives. But that type of signalling is very fundamental to any kind of neurologic function. And so being able to work on that signalling pathway is just a wonderful way to get down to root cause.
Andrew: So you were mentioning the healing cycle and that you might be able to intercede to help these kids with neurodevelopmental disorders. What is the healing cycle, and what are the hallmark disorders seen here?
Elizabeth: So, basically, the stages of healing are driven by bioenergetics. So it's not just biochemistry, but it also has to do with energy and light and a lot of probably things we don't fully understand now.
When you're working on a car, you know, you might kind of use an engineering model to sort of just figure out what's wrong and replace the parts. But with humans and animals, we have to look at systems biology, which means there are lots of different metabolic differences, hundreds of gene mutations, and hundreds of measurable analytes that are related to various types of chronic disease.
So, basically, you know, nature goes through this healing cycle and goes through kind of a reboot of the various pathways, and then attempts to reintegrate the cell and reestablish function. So when Dr Naviaux lectures, he'll talk about the cellular defence response, one going to two, one...and going to three, as different parts of the healing cycle.
So, we ought to rethink about a state of chronic illness, and instead of just thinking of it as illness, if we could think of it as vigorous health not being restored, then we can put a positive spin on it. And there're possibly a relatively small number of interventions in that healing cycle or nutritional support or biochemical cofactors that we could give that might really impact, and I hesitate the use the word "cure," but I think "cure" is on the horizon, hundreds of diseases. So rather than having hundreds of solutions, we may be able to, through this careful analysis of these analytes, look at what they need to move forward.
So cells are always in different states of function, and with chronic illness, it's sort of self-sustaining. It's like a vicious cycle, and we talk about wanting to turn the vicious cycle into more of a victorious cycle.
Elizabeth: So, healing can be self-sustaining, if it's just not blocked. So part of this is getting rid of the roadblocks.
Andrew: But there's got to be a stage where the mitochondria becomes so dysfunctional that your body just says, "You know what? You're too oxidised, you're too damaged, we're going to tear you down and start again." Is this where...
Andrew: Yeah. Is this where the cell danger response can cause both fatigue and hyperexcitability, like depending on what's happening with the mitochondria?
Elizabeth: So, you're talking about a process of essentially cellular suicide, which is an important adaptive response.
So, you're exactly right. At some point, when the cell is damaged beyond repair, what it wants to do for the good of the rest of the body and its neighbouring cells is to commit suicide. And there are a number of triggers or messages that give the mitochondria that signal that it's time for them to sacrifice themselves for the greater good.
Elizabeth: So the interesting thing about that is that we now know that there are a number of ways that we can increase what's called ‘mitochondrial biogenesis.’ Meaning, helping you make new mitochondria. So I'll mention just a couple of those.
One that's getting some interest lately is the idea of intermittent fasting. Because mitochondria like periods where they aren't having to process food 24/7. And, unfortunately, in America, we have, you know, very bad eating habits where we have 24/7 access to food and people, you know, if they can't sleep are getting up in the middle of the night and making themselves snacks.
Andrew: Yeah, yeah.
Elizabeth: But we know that the mitochondria really like these periods of fasting. The other thing they really like is exercise. And so when you do vigorous exercise, you help generate something called brain-derived neurotrophic factor, and you give your mitochondria a boost also.
Then there are other things that help you build new mitochondria, like hyperbaric oxygen therapy. Where you're giving concentrated oxygen under pressure that diffuses into the plasma, so you can actually get to places in the body with the plasma, which can diffuse pretty much everywhere, as opposed to only depending on your red blood cells, which aren't going to be able to deliver oxygen if there's blockages like strokes or plaques, for example.
So cell suicide, and then making new mitochondria is a big piece of this. So, you're exactly right that mitochondrial dysfunction is highly implicated in things like chronic fatigue syndrome, but also in certain hyper-agitated states, especially those having to do with the imbalance between glutamate and GABA.
So, briefly, glutamate and GABA should be in kind of a balance in our brains, but if you get high glutamate, you tend to be agitated or hyperactive. You need a certain amount of glutamate to be able to be awake enough and alert enough to be able to think well. But when you get too much, like in someone who's drinking a lot of diet sodas with aspartame in them or other MSG products that make too much glutamate, then you'll have that hyperexcitability. And then GABA is an amino acid that should be affecting you in a calming way. So this GABA and glutamate balance is something that's going to promote good mitochondrial function in the organism.
Andrew: Okay, so you've got two phases here of the mitochondria, one where you can heal it, one where you're body's going to tear it down, start again, create an apoptotical, autophagy situation, autophagic situation.
So how do you, as a clinician, know where you're headed here? Do you just do the general things of exercise and intermittent fasting and good rest and avoiding the high glucose-type foods so that you're not getting a hyperexcitability and let the body manage that?
Or do you have a phase sort of thing where you say, "Listen, your symptoms are more indicative of your mitochondria being able to be repaired, so we'll go that way. Or your symptoms are more indicative of an apoptotic situation being imminent, so we need to look after you in a different way?" I know that's a very general question because there are of thousands of mitochondria in each cell, but, like, do you tend to sort of do a biphasic treatment response here, or just general guidelines?
Elizabeth: So what I tend to do is, first, to always go back to the history of the patient. And so if I hear symptoms that suggest mitochondrial dysfunction in babies, it might be that they're very sloppy and they aren't making their developmental milestones.
Elizabeth: In adults, it might be chronic fatigue or just not having energy to work the way they might have worked earlier.
So the first piece of it is to figure out if there is indeed mitochondrial dysfunction, which you can do through lab testing, and then try to figure out what it is that's blocking that function, and take it away if you can or treat it if you can.
So, for example, chronic tick-borne diseases might ultimately lead to mitochondrial dysfunction. Profound nutritional deficiencies might ultimately lead to mitochondrial dysfunction. Various bad infections might lead to mitochondrial dysfunction. Traumatic situations or experiences might have a bad impact on the mitochondria.
So, once you've identified that those are the symptoms, then I would go about providing… getting rid of whatever blocks you can, but also providing whatever support to the mitochondria that you might need to give.
So, for example, you might want to give certain nutrients. Famously, the B vitamins, particularly riboflavin and niacin, are important for the mitochondria to use as part of the process where it goes from complex I to complex V, and get the process started. Co-Q10, which you can get as a supplement, will help with complex III action in the mitochondria, and again, move it forward. Oxygen and vitamin C are both needed for the mitochondria so you can look at ways to oxygenate or hyperoxygenate the cells and ensure adequate doses of vitamin C.
With regards to sort of throwing up our hands and saying, you know, your mitochondria are dying, you know, we're just going to let that happen. I don't tend to do that. I feel like the body is the only one, or the cell is the only one that really gets to pull the trigger on that apoptotic pathway.
Elizabeth: So, our job is to give the body what it needs and, honestly, let it sort it out in terms of once that process has gone on too long, it can decide which cells to destroy.
Andrew: Yeah. Mitochondria can benefit from a stressful stimulus as long as it's short term to sort of kickstart them…
Elizabeth: Yes! Yes.
Andrew: Back into normality.
Andrew: So as long as you give that short term rather than chronic. I guess that the issue is you got to be mindful to take away the chronic stuff.
Elizabeth: Yes, yes. And a good example is people with chronic fatigue that really don't have much energy to exercise, but even just a few minutes of exercise or movement and a little bit of mitochondrial stressing is actually good in that situation.
Another example is hyperbaric oxygen therapy, which we know, in and of itself, is going to initially cause a little bit of oxidative stress, but then you awake some of the adaptive mechanisms and go on to get the benefit. So, you're exactly right on that point.
Andrew: Okay. What are the main ways though, in which our bodies normally cope with cell danger signals? And I guess you've discussed some ways in which we can intervene to address an adequate recovery, but when somebody's really failing, what do you need to do? How do you need to intercede?
Elizabeth: Okay. So, when the body perceives itself to be under danger, one of the things the mitochondria do is shift the metabolism so that whatever the dangerous source is, like, for example, a virus or bacteria, can't hijack the cellular materials for their own purposes. It also, and I think I mentioned this earlier, stiffens the cell membrane…
Elizabeth: So that it limits access from the pathogen into the cell. It also sends out some antiviral and antibacterial chemicals all around the cell to try to protect the surrounding cellular buddies. And it tries to alter gene expression in ways that will be protective for the host. It warns neighbouring cells that they're under danger, and then we’ve talked about how it alters the behaviour of the host to have more of a sick behaviour to facilitate healing and not spread to other people.
Now when people haven't been recovering well, I like to look at very fundamental back-to-basics kinds of approaches. So when you look at complex history, there's a number of areas of lifestyle medicine that you need to look at. One, obviously, is nutrition, good sleep, movement and exercise, fostering resilience in the patient, and being able to handle stress.
So that gives us five pillars to work on no matter what the chronic condition is. So, we would go first to nutrition. We often start with the diet. People's eating habits are challenging to change, but probably one of the most important things we can do.
We know that if you track all-cause mortality from all kinds of diseases, the thing that really correlates with less risk is the number of servings of fruits and vegetables. So, one way you can intervene in all chronic illness is to see if you can get your patient to do three green vegetables a day, three coloured vegetables a day, and three sulfury vegetables like onions and fennel, which will help the detoxification system.
You mentioned, you know, avoiding sugar, avoiding preservatives, eating whole foods. There are a variety of diets that are specifically good for specific situations. For example, in someone that has a lot of gastrointestinal inflammation, you may want to use the specific carbohydrate diet because that's been shown to be very effective to heal gut inflammation. There may be other situations where you would do a gluten-free diet, or a casein-free diet, or an anti-inflammatory diet, in which you avoid foods, such as nightshades, that will trigger autoimmunity and inflammation in some people. So food and nutrition is what I would characterise as the first pillar.
The second thing you can do for pretty much any condition is to work on sleep. There's new research actually from my alma mater, from the University of Virginia, in the last two years that has shown us that we actually have a lymphatic system in our brain, it's called glymphatics. And for many years, we didn't know about this.
Andrew: Ahh, yes.
Elizabeth: But now we know that when we sleep, our brain cells actually shrink a little bit, and this fluid washes over them, and it essentially helps you to take out the trash.
So, one of the problems of people that have PTSD or chronic fatigue or chronic pain syndromes is that their sleep is so disrupted that they can't do that ‘taking out the trash’ every night, and that makes them more susceptible to, you know, getting stuck in one of those vicious cycles where they can't get rid of whatever toxin it is that's making them worse. So there are lots of strategies to promote sleep that clinicians can use to help with that.
Exercise is another important thing. We talked about the positive effect of exercise on the mitochondria and on cognitive function. It also is particularly good at helping you not feel depressed. So, you know, these things that I'm mentioning like cognitive decline and depression and fatigue, these are all signs that our mitochondria aren't functioning appropriately, and that we may be locked in a maladaptive phase of the cell-healing cycle. So, attention to exercise or movement is important.
And then stress management and cultivating resiliency are other ways where you can have a global effect on multiple different conditions.
Elizabeth: So, you know, for our children, we want to have them in a nurturing environment where they know that people love them and their basic needs are met, but also that they feel safe and can share things emotionally.
For adults, we want them to develop, you know, various stress management strategies that work for them. You know, meditation or exercise or confiding in a friend, whatever it is that works for them is going to, again, give the body some of what it needs in order to get unlocked from the block in the cell's healing cycle.
So, those lifestyle pillars will work for everybody, and we just have to do a little work to fine-tune the different recommendations.
Andrew: Yeah. So just speaking about kids with neurodevelopmental issues, autism, ASD, ADHD, all that sort of thing. Where a trigger, whether it be a noise, whether it be, you know, a child bullying them. Some trigger for them, and they tend to explode, it's like it's an impulse, it's immediate, it's very forceful at times. How do you, do I say the word "train?" How do you teach them to react in a different way, once they've sort of, you know, the initial, call it, primordial response would be to explode, but how do you train them to say, "Okay, we need to do this rather than, you know, hit back, or lash out, or throw chairs?"
Elizabeth: Right. So one of the things you're addressing is the very fundamental state of the child, and many children in autism tend to be in what we would call "sympathetic overdrive."
Elizabeth: That basically means that they live in sort of fight-or-flight mode most of the time. And there are a number of ways you can improve the parasympathetic response. So let me mention a couple of those.
So sympathetic is fight-or-flight, or flee. Parasympathetic is rest-and-digest. And we want them to spend more time resting and digesting and being able to cuddle on the sofa with their parents and be open to learning things.
So, parasympathetic tone is improved by any kind of deep pressure. So, we will build into the child's day the parents giving them deep hugs. Some kids use weighted blankets or weighted vests. Another thing that promotes parasympathetic tone is repetitive movement, like swinging or trampolining. And so many kids find that if they incorporate that into their day, they will be calmer. And the other thing that we work on is the vagus nerve.
Elizabeth: So the vagus nerve is the wandering nerve that goes through all parts of the body, and an easy test to look for how well the vagus nerve works is to have the child open their mouth and say "Aaah." And if the uvula, which is that little thing that hangs down the back of your throat in cartoons, deviates to the right or to the left, that's a quick and dirty sign that the vagus nerve is not working well.
Andrew: Aaah. Okay.
Elizabeth: Yeah. Constipation is another very classic sign of vagal nerve dysfunction.
So, we can use various types of allied health professionals, like chiropractors, to help us work on the vagal nerve tone through their manipulations and massages and such.
We know that massage is good at getting you into parasympathetic tone. But we also now know that it's good for mitochondrial biogenesis also.
Elizabeth: So, a massage might put you into parasympathetic tone, and also give you more mitochondria. So that's a good way to go.
Elizabeth: So, I would say the first thing is to, you know, address getting them into parasympathetic tone before you try to train them. It's very hard to train a kid not to have a rage attack when they're in the middle of having a rage attack.
Elizabeth: So, we get them into parasympathetic tone, and then we work on giving them information like, you know, you can feel whatever it is you want to feel. Your feelings are legitimate, but we can't allow you to hurt yourself or other people.
Elizabeth: So, we're going to work on ways to, you know, get out of that.
Magnesium should be in our vegetables, but we've over-fertilised the soil with phosphates and potassium, which compete with magnesium. So, in my area, Thomas Jefferson had a home just a few miles from here, and he grew lots of vegetables that were very magnesium-rich. Now, we don't have that much magnesium in our vegetables.
So magnesium is good for calming the neurologic system. So if you've got a chronic magnesium deficit, you're likely to have things like ticks or twitches or anxiety. But you're also likely to be quick to anger and to have less ability to dampen down those feelings of rage. So, we tend to push magnesium doses for various reasons, but to help with calming the child overall, and helping them to gate their sensory stimuli.
Elizabeth: So, for example, magnesium is one of the things that helps you not continue to find it unpleasant to hear, like, a firetruck.
So, normally, you hear a fire siren, and at first, it kind of startles you, but as soon as you recognise where it is and where it's coming from and what it is, and that, you know, you can pull over, you know, you shouldn't continue to be upset by that. Because the sensory stimuli is being gated or managed. So, magnesium really helps with the kids where, as you say, a sudden loud noise or somebody scaring them might put them into fight-or-flight.
Elizabeth: There's also a little bit of a SNP, a single nucleotide polymorphism called COMT, catechol-O-methyltransferase. It's an enzyme that has an important function in helping us break down epinephrine and norepinephrine, which are the messages of danger, danger, something's bad happening, and it makes your heart rate go up, and it makes your pupils dilate, and it makes you ready to either run or fight.
So, in people that have that particular genetic variation, they are not going to break down those excitatory neurotransmitters as fast as other people would. In fact, it may last as long as four times as long. So, you know, if we get startled, we might realise who's coming and only be scared for three to five seconds, but, you know, kids with that problem may stay agitated for much longer.
Andrew: Yeah. So methylation support, that sort of thing as well?
Elizabeth: We work a lot on methylation and folate biochemistry because it's very fundamental for so many downstream body functions.
It is fundamentally one of the ways that we regulate our gene expression. And we learn to, you know, make new cells when it's appropriate, but not make new cells when it's not appropriate. Like cancer cells, if you have cancer.
It also is very important for us to generate normal cell membranes and normal neurotransmitters. And it serves as a gateway to our detoxification pathways, our repair of our gastrointestinal tract, our immune system as well as our mitochondrial system. So when we do methylation support, we're actually also doing mitochondrial support, and that's a big part of the picture.
Andrew: Yeah. And do you tend to use different forms of magnesium? Because, you know, you haven't just got the muscle relaxing properties so the...you know, the favourite forms amongst practitioners are the, you know, bisglycinates, the aspartates, that sort of thing. However, you can use the oxides to ease constipation so...once you've got decent doses up. Do you tend to use different forms of magnesium when you're helping these kids raise their magnesium levels?
Elizabeth: Yes, I do. If I've got kids who are constipated, we tend to use magnesium citrate more than you do in Australia. But I know in Australia, you use magnesium oxides for that, which is perfectly good.
If you've got a child that has chronic diarrhoea, we would look at more GI neutral forms. Those would include things like magnesium taurate or magnesium glycinate. And if it's a child that really has the sort of CNS aspects of magnesium deficiency like extreme anxiety, agitation, ticks and twitches, sometimes we'll use magnesium L-threonate or magnesium maleate, which, theoretically, are better at helping you with those CNS aspects of magnesium deficiency.
Elizabeth: So, it's part of the art and science of medicine working together to make those small changes.
Andrew: Yeah. And you were talking earlier about, you know, the cell's releasing chemicals to protect itself. One of those chemicals is histamine in the brain. But it's got a counterintuitive action in the brain. So, you know, the cell danger response has been termed ‘the allergy of the brain.’ And, you know, I would dare say, well, why not give antihistamine?
Elizabeth: Right. So, the histamine issue is very interesting. Because this is something that should be protective for us, but when it goes too extreme, you end up with rashes and hives, and sometimes behavioural effects even from certain high histamine types of foods.
So when we talk about allergy in the brain, that is, to me, not a simple allergy, like, you know, I'm allergic to, let's say, a bee sting. So if I get bitten by a bee, I'm going to swell up and get red and maybe have trouble breathing. It's really more of a global immune dysregulation.
So, some of the things we look at in the kids who have either histamine intolerance or there's even something called ‘mast cell activation syndrome.’ It can be pretty much over the body. And so in the GI tract, they might have diarrhea and nausea, or they might get an itchy throat or throat swelling. In their respiratory tract, they might wheeze. In the cardiovascular system, they might be dizzy, or have a tachycardia, which is rapid heart rate. Neurologically, as you're alluding to, it can present with headaches and poor memory and anxiety. And on the skin, you know, sometimes we see what's called dermatographism, where you write on the skin, or the actual hives, which is when the histamine is really being released.
Quercetin is very valuable in helping to heal an inflamed brain. It is sometimes combined with rutin and luteolin for major healing effect. One of the researchers that worked on this is Dr Theo Theoharides. He works in Boston and has done an incredible amount of work in mast cell activation syndrome.
We also look at good fats for the brain. Things like omega-3 essential fatty acids, which help with cell signaling, and help make cell membranes very fluid. Phosphatidylcholine and phosphatidylserine are also good at helping with cell membrane function.
You essentially want to have very fluid and adaptable cell membranes. You don't want them to have a very stiff borders. This makes it harder for various ions, or medications, or hormones to exert a cellular effect if they don't have a nice fluid membrane.
The very stiff membrane or the wrinkled membrane, it would be like trying to dock a spaceship to a docking station that didn't have the right shape or confirmation. So, lots can be done on brain healing, and I think that this is an area of research that will continue to march forward very rapidly.
Andrew: Can you comment on the pharmacological approach of symptom control versus the nutrition and lifestyle interventions that you've mentioned? Like, do you need medications sometime or can you really get away from them?
Elizabeth: I am a traditionally trained doctor, and I do think you need medication sometimes. However, I do think that the way we have put all our eggs in the basket of pharmacology has not been good for our patients.
So, for example, I do a lot of work with parents who bring their children to me because they have trouble in school with so-called ADHD, attention deficit problems. We like to take a very big history about their diet and nutrition, their exercise patterns, their home situation, their sleep patterns, and work on those pillars first.
Unfortunately, at least in the United States, the model is that to be a thriving pediatrician and get reimbursement from insurance companies, you schedule your patients every 15 minutes.
Elizabeth: And it's very difficult to do the kind of work I like to do in that context. So, many people will go to a pediatrician, maybe with some questionnaires from their teachers or complaints from the parents, and if the child meets the so-called criteria for ADHD, they will walk away with a prescription for a stimulant.
I do not like to do things that way, and we have actually had many kids who changed their diet, you know, got rid of pop tarts for breakfast and potato chips for dinner, and started actually eating whole foods, like fruits and vegetables, and good proteins, and good fats, and actually giving their brain the kind of fuel it needs in order to be able to think.
One simple thing is that many kids are zinc-deficient. Zinc is found in things like oysters and mussels and certain seeds. And most toddlers and young children are not going to really eat those foods. So, when you're deficient in zinc, you have trouble thinking. So, sometimes just supplementing zinc is helpful.
Sometimes omega-3's can be very helpful for ADHD. So, I'm glad you asked me about this because Nancy O'Hara is going to spend a whole hour talking about this at the conference that we're giving in late March in Sydney…
Elizabeth: And she's got a much longer list than what I just presented about how we can do things without medications in certain situations.
Elizabeth: I think that medications are great, and traditional medicine is great when you're doing an acute rescue of someone. But not necessarily so good a track record when we're dealing with chronic disease.
If you look, for example, critically at the drugs that are commonly prescribed for conditions like arthritis, we realised that they really don't help that much long-term. Same has been demonstrated for cognitive decline in situations like Parkinson's and Alzheimer's. You know, those medications have really not worked well despite all the millions and billions of dollars we've spent on them.
So, I think this idea of restoring the healing cycle, giving the body what it needs in order to heal, and taking away the stuff that's interfering and blocking that healing cycle is the wave of the future.
Elizabeth: Well, one of the things I'm excited to talk about is migraine headaches in children.
Elizabeth: In the past, we've looked at a number of medications to treat, but we know now that depending on the ages and stages of the child, that there are different types of presentations for migraine, and certain kids will actually present with more abdominal symptoms than headache symptoms. And so if we can identify what the triggers are, and then use some strategies to figure out how to prevent them from coming back, that's going to be more effective than just, you know, waiting for a migraine to happen, and then trying to give a medication that's going to abort it.
And I've got an interesting case to present about a very, what seems like unusual cause of migraines, which was a young woman in her teens, that had extremely large breasts with a bra cup size of J. And the thing that cured her migraines was breast reduction surgery.
Andrew: Yeah, yeah.
Elizabeth: So, it just make you realise, again, how multiple conditions can contribute to a certain, "disease" or "condition," but if you go upstream and deal with the cause, then it makes a big difference.
Another thing I'm going to be talking about is cerebral folate defiency. We know now that many children who have neurodevelopmental problems have autoantibodies against either their folate receptors, either binding or blocking antibodies. And folate is crucially important for brain function.
Typically, what happens is that we eat folate in the form of dark, leafy green vegetables. We have an enzyme that's supposed to convert that into the active form that can go into the methylation cycle, and then be ultimately used by the brain and the neurologic system. But some people have an impairment in that enzyme, or they have these blocking or binding antibodies. And if you have cerebral folate deficiency, it can present relatively subtly in infancy with just some developmental delays. But as the child ages up, it becomes more and more severe and can lead to horrible seizures and mental retardation. So, recognizing it early and just providing...you know, sometimes a relatively small amount of the active form of folate can be life-saving for that brain.
We're also going to talk about allergies. Things like allergic rhinitis and asthma and eczema. And rather than just giving a medication for each of those things, we'll talk about underlying conditions and causes, how to remove the environmental triggers, and that should be great.
And then Nancy's talking about PANDAS, which is paediatric autoimmune neuropsychiatric syndrome associated with strep. And there's also PANS, which is paediatric acute neuropsychiatric syndrome. Those are both conditions in which the child's behaviour is dramatically changed, often very quickly, as a result of certain infections. So, the typical story is I put my child to bed last night, and she seemed fine, and then she woke up this morning, and she had acute separation anxiety, and she became very OCD, and this is totally unlike her. So, we'll talk about that emerging research and what we can do to help the kids.
Nancy is also going to talk about some of the things you've been mentioning in terms of chronic infections. And Bob Naviaux is going to share some of his excellent work on chronic fatigue syndrome and how that all ties in with...
Elizabeth: ...his work with cell danger response and the healing cycle. And then Nancy is going to talk about Lyme disease. She practices in Connecticut, which is where Lyme disease was originally worked on. And you guys now have it in Australia, and so that'll be very interesting.
So, we're so excited to come back. First of all, we all love Australia. But secondly, we find that your clinicians are so bright and so dedicated to their patients, and that they're willing to go the extra mile. And so we always learn a lot from the clinicians in Australia when we're brought in as the so-called experts. So, can't wait and very excited, and I hope a lot of people come to take advantage of the opportunity.
Andrew: Absolutely. And indeed, I will urge all clinicians that can make the Mindd Forum. It is a beautiful foundation set up by Leslie Embersits, who has the utmost dedication and care for kids with neurodevelopmental issues.
And I've got to say, Liz, that, thank you for the accolades to our practitioners. But you know what? It's because of the care and compassion of you and your colleagues, that we are able to springboard from that, from what we learn from you. So thank you so much for taking us through. I mean, this is really the tip of the iceberg that we've touched on here. We didn't have enough time to go into anything, which doesn't really give it any credibility.
So, you really have to dive deep by attending the Mindd Forum in 2019. And, Liz, I'd love to thank you for sharing your expertise and passion and compassion for these kids, and the support of their families today on FX Medicine.
Elizabeth: And I will tell you that I've learned so much from the families of these children. They're the ones that noticed so many things about their children's symptoms that went on to drive research.
So, if a clinician listens to the family, we learn a lot from them also. So this work has been very inspiring to me because I see how dedicated these families are and it makes all of us just want to help in any way we can.
Andrew: Well said. This is FX Medicine. I'm Andrew Whitfield-Cook.
|Dr Elizabeth Mumper|
|2019 Mindd Forum International|
|The Rimland Center for Integrative Medicine|
|Advocates for Children|
|Advocates for Families|
|Dr Robert Naviaux|
|Autism Research Institute|
|Dr Nancy O'Hara|