Brought to you by Anne J. Ford, MSW, LICSW

If you’re a mom with ADHD who is struggling to raise a child, or    children, with ADHD, it’s time to take heart. Here are ways to ease the journey of parents who share a diagnosis with their kids.  Several authorities share similar advice:

• Keep your cool when clueless people tell you to “just stay calm. This is an extremely challenging task and mom needs to find some stress reducing ways such as yoga, walking, friend’s time consistently.
• Monitor yourself and self correct when needed. Sleep, exercise and eating habits can help or put you into the “upset zone.”
• Medication is not magic. Meds most likely will not solve all of your problems, they may reduce hyperactivity and inattention, they do little to lessen parenting difficulties. Behavioral therapy among others is needed to improve social interaction including family relationships.
• Hold “fire drills’ with your kids. Handle conflict at a no conflict time. Talk about what you all can do next time you aren’t calm. Then act it out, go to time out, use problem solving strategies.
• Avoid finger pointing. Don’t blame everything that goes wrong on one family member. Family members influence each other, it’s best to acknowledge the ways which everyone contributes to a conflict, everyone learns.
• When you find you’re in a power struggle, back out. No more destructive battles, find a way to discuss the limit setting at a calmer time.
• Don’t sweat the small stuff. Parents consider which power struggles should be pursued, as matters of safety and which should be let go for the sake of the family’s sanity.
• Manage bad behavior. Sometimes a parent who shares a diagnosis will identify so closely with a child that she or he will fail to set appropriate limits. There’s a fine line between explanation and excuse, be specific.
• Outsource what ever you can. Find out if your school offers help with homework or if your child has accommodations, request a lighter homework load. If you can afford it, hire a tutor.
• Maintain your SENSE OF HUMOR.

ADHD never goes away, but you can make improvements by managing
symptoms and learning new therapies that can increase skills for
processing, pacing and improve self control.

Adapted from Kathleen Nadeau Ph.D and Andrea Chronis-Tuscano Ph.D
article, "The Double Whammy Game Plan."

 

NDNR Naturopathic Doctor News & Review

Categorized | Autoimmune/Allergy Medicine
Article found online at: http://ndnr.com/web-articles/autoimmuneallergy-medicine/gluten-sensitivity-vs-celiac-disease/

Gluten Sensitivity vs Celiac Disease
Posted on 19 April 2012.

Two Distinct Clinical Entities
Nate Champion, ND

It seems as if more and more individuals are being seen with clinical symptoms associated with adverse reactions to gluten, the structural protein component of wheat, barley, and rye. Often, these patients have already been to see a gastroenterologist, and many have had serologic testing performed for celiac disease (CD), wheat allergy, or both. When the results of their blood work come back negative for antibodies to gluten, these patients are often told that wheat or gluten is not a problem and are offered little other advice. These patients are many times left confused, discouraged, and frustrated without any answers and wonder where to go from here. As NDs, we have known for years that individuals can have problems arising from gluten without having true CD. More recently, our understanding and knowledge of gluten sensitivity (GS) has grown, and research has begun to reveal evidence that GS is a separate clinical entity from CD.1

Wheat Allergy and CD

The 2 best-known illnesses related to gluten exposure are wheat allergy and CD, both of which are mediated by the adaptive immune system, with the reaction to gluten being mediated by T-cell activation in the mucosa of the gastrointestinal tract. However, in wheat allergy the release of chemical mediators (histamine) from mast cells and basophils is triggered by the cross-linking of IgE.2 In contrast, CD is an autoimmune disorder indicated by specific serologic markers, most notably serum tissue transglutaminase autoantibodies. Besides CD and wheat allergy, there are many individuals who experience gluten reactions in which neither autoimmune nor allergic mechanisms are involved, generally defined as GS.3

GS vs CD

Gluten sensitivity affects approximately 10% of the general population and is considered a diagnosis of exclusion in which patients are considered to be “gluten sensitive” after CD, wheat allergy, and other clinically overlapping diseases (inflammatory bowel disease, type 1 diabetes mellitus, and Helicobacter pylori infection) have been ruled out. In addition, symptoms are triggered by gluten exposure and are alleviated by gluten avoidance. In contrast to CD, which affects approximately 1% of the general population, these adverse symptoms that occur while eating gluten are not followed by the appearance of autoantibodies in the blood or by persistent damage to the small intestine. Table 1 lists characteristics of GS vs CD. A 2011 landmark study3 reported for the first time evidence of different responses in the intestinal mucosa to gluten in GS vs CD. This study showed significantly reduced small intestinal permeability in patients having GS compared with those having CD when tested with a lactulose and mannitol double-sugar probe.
Patients with GS do not seem to present with significant autoimmune or allergic comorbidities, and their serologic test results are negative for common autoantibodies, including transglutaminase IgA. In CD, there is a strong genetic association with the class II major histocompatibility complex proteins. About 95% of patients with CD carry the HLA-DQ2 gene, and the remaining 5% carry the HLA-DQ8 gene. Only about 50% of patients with GS carry either HLA-DQ2 or HLA-DQ8 (a percentage only slightly higher than that in the general population). This suggests that the adaptive immune system has a much more limited involvement in patients with GS and may explain why this condition is not accompanied by significant autoimmune phenomena, as in CD.3 This adaptive immune response in CD has been shown to be triggered by tissue transglutaminase deaminated gluten peptides bound to DQ2 or DQ8. This mucosal recruitment and activation of the helper T cell, subtype 1 (TH1) and TH17 clones and their associated cytokines (interferon γ and interleukin [IL] 17A) contribute to the initiation of tissue damage and disruption of barrier function. In addition to IL-17A, IL-6 and IL-21 (both of which promote differentiation of TH17 cells) are expressed at significantly increased levels in the mucosa of patients with CD but not in those with GS.4 Furthermore, other investigations have demonstrated that IL-17A cytokines are expressed at significantly higher levels in the small intestinal mucosa of patients with CD but not in those with GS. The authors of one study state: “We conclude that GS, albeit gluten-induced, is different from CD not only with respect to the genetic makeup and clinical and functional parameters, but also with respect to the nature of the immune response.”5(p75)

Toll-like receptors (TLRs) have a crucial role in the initiation or maintenance of various immune responses in the innate immune system. One study3 compared the expression of various TLRs using fresh intestinal biopsy specimens from patients with GS or CD. Small intestine expression of TLR2 was significantly increased in patients with GS. TLR1 and TLR4 were generally higher, without reaching clinical significance. Results of this study suggest that the innate immune system has a prevalent role in the pathogenesis of GS, whereas in CD it is the adaptive immune system that has the primary role. More studies are needed to confirm these results, but this finding may help explain the clinical and serologic differences in GS vs CD.

Clinical Implications

So what is the clinical relevance of identifying patients with GS vs those with CD? Is it possible that changes in the innate immune system may precede or accompany the progression of CD and other autoimmune conditions? Based on the current research, it may be too soon to tell. However, investigations have demonstrated that the expression of various TLRs is increased in the small intestinal mucosa of patients with CD, which may lend support to this idea.6 The typical lesions found in the intestines of patients with CD are thought to be mediated by both innate and adaptive immune pathways. Based on the landmark study3 already cited, it seems that GS is associated with prevalent activation of an innate immune response.

When possible, I believe that it is essential to differentiate between GS and CD (tolle causam). It is important for many obvious reasons to understand if you are working with an autoimmune disorder like CD because it can lead to other secondary disorders (thyroid disorders, infertility, etc), not to mention the importance from a genetic and family history standpoint. More and more research has been demonstrating the adverse effects that gluten can have on an increasing percentage of the population. These often include your typical gastrointestinal symptoms, such as gas, bloating, abdominal pain, diarrhea, and constipation. However, many other extraintestinal symptoms involving psychiatric and neurologic manifestations can often present as well. Neurologic manifestations of GS with or without enteropathy are also common. These clinical manifestations can vary, but the most common syndromes involve peripheral neuropathy and cerebellar ataxia. Earlier detection of GS could provide remarkable benefits to patients with neurologic manifestations.7 Finally, Table 2 gives an immunologic overview of the innate immune system vs the adaptive immune system.8

Summary New research has enhanced our understanding of GS and CD and has shown them to be 2 distinct entities. More double-blind placebo-controlled studies are necessary to further our understanding of GS and to search for specific biomarkers for a proper diagnosis because there is still much we do not know in this regard. The objectives of this article were to inform the clinician about this new research, to further our understanding of these conditions, and to better equip us in the care of our patients. I believe that this information is valuable to our patients as well because it gives credence to what they often experience but rarely have acknowledged by other medical professionals, especially those in allopathic medicine. As NDs, we already have diagnostic tools and specialized testing that we use to detect gluten sensitivities and are in an excellent position to help this growing population of individuals.

Table 1. Characteristics of Gluten Sensitivity vs Celiac Disease

Gluten Sensitivity	Celiac Disease
Affects ~10% of the population	Affects ~1% of the population
No autoimmune component	Autoimmune condition
Reduced intestinal permeability	Increased intestinal permeability
Activation of innate immune response	Activation of adaptive immune response primarily
No genetic association	Strong genetic association
Increased levels of innate marker Toll-like receptor 2	Increased levels of IL-6, IL-17A, and IL-21
Negative serologic and histopathologic findings	Positive serologic and histopathologic findings

Abbreviation: IL, interleukin.

Table 2. Immunologic Overview of the Innate Immune System vs the Adaptive Immune Systema

Innate Immune System	Adaptive Immune System
Nonspecific immunity	Specific immunity
First line of defense	Second line of defense
Response is antigen independent	Response is antigen dependent
There is an immediate maximal response	Lag time between exposure and maximal response
Not antigen specific	Antigen specific
Does not demonstrate immunologic memory	Demonstrates immunologic memory
Phagocytic cells, natural killer cells, basophils, mast cells, eosinophils, and platelets	B and T lymphocytes, B cells can differentiate into plasma cells, T cells can differentiate into T cytotoxic or helper T cells

aFrom Mayer G. Immunology Textbook. 7th ed. http://pathmicro.med.sc.edu/ghaffar/innate.htm.8
Nate Champion, ND is a graduate of Southwest College of Naturopathic Medicine & Health Sciences, Tempe, Arizona. He is founder and co-owner of Champion Naturopathic Health, LLC, Minnetonka, Minnesota. Dr Champion has a private practice in Minneapolis, Minnesota, with a special focus in digestive disorders, particularly inflammatory bowel disease. In addition to his practice, he regularly reviews research and writes reports on natural medicine for a private health advisory company. 

For more information, please visit www.championnh.com and www.pih-mpls.com.
 References
1. Jackson JR, Eaton WW, Cascella NG, Fansano A, Kelly DL. Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity [published online ahead of print August 30, 2011]. Psychiatr Q. doi:10.1007/s11126-011-9186-y. Medline:21877216
2. Tanabe S. Analysis of food allergen structures and development of foods for allergic patients. Biosci Biotechnol Biochem. 2008;72:649-659.
3. Sapone A, Lammers KM, Casolaro V, et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med. 2011;9:e23. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065425/?tool=pubmed. Accessed November 17, 2011.
4. Castellanos-Rubio A, Santin I, Irastorza I, et al. TH17 (and TH1) signatures of intestinal biopsies of CD patients in response to gliadin. Autoimmunity. 2009;42:69-73.
5. Sapone A, Lammers KM, Mazzarella G, et al. Differential mucosal IL-17 expression in two gliadin-induced disorders: gluten sensitivity and the autoimmune enteropathy celiac disease. Int Arch Allergy Immunol. 2009;152:75-80.
6. Szebeni B, Veres G, Dezsofi A, et al. Increased mucosal expression of Toll-like receptor (TLR)2 and TLR4 in coeliac disease. J Pediatr Gastroenterol Nutr. 2007;45(2):187-193.
7. Hernandez-Lahoz C, Mauri-Capdevila G, Vega-Villar J, Rodrigo L. Neurological disorders associated with gluten sensitivity. Rev Neurol. 2011;53(5):287-300.
8. Mayer G. Immunology Textbook. 7th ed. http://pathmicro.med.sc.edu/ghaffar/innate.htm. Accessed November 16, 2011.

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It's Infertility Awareness Week from April 22-28. So many people are struggling with infertility.  LISTEN.  ASK.  HELP. 

Partners in Healing of Minneapolis was well represented at Resolve's Annual Family Building Conference in Minneapolis over the weekend.  Dr. Deborah Simmons, Dr. Nita Champion, and Diane Tanning, L.Ac. presented information on how to approach a new infertility diagnosis, depression and anxiety related to fertility challenges, gestational surrogacy, when to let go of biological dreams, naturopathic medicine to treat infertility, and Chinese medicine for infertility.  Don't Ignore Infertility.

 

Dr. Deborah Simmons will be speaking at the annual conference of Resolve, the National Infertility Association on April 21st at Calvary Lutheran Church in Golden Valley, MN.  She will be speaking on gestational surrogacy, depression and infertility, and decision-making about ending treatment.  Join with the Resolve community for information on Western and holistic fertility treatment and adoption.  For more information, go to Exploring Paths of Hope: 28th Annual Infertility and Adoption Family Building Conference

Based on the whole person, integrated therapy addresses the needs of individuals with Asperger’s and high functioning autism.  At Partners in Healing, Anne Ford, MSW, LICSW provides a treatment approach compatible with each individual’s ability, interests and goals.  She provides empathetic, upbeat therapeutic approaches and research-driven explanations of the inner world of individuals on the spectrum.  Anne Ford works to create new concepts and workable strategies for the individual to function and find sources of satisfaction in his or her life.

Individual, Couple, and Family Therapy
Individual, couple, and family therapy involve insights and new behaviors that empower individuals to explore their role in their relationships whether it is in their family, work setting, school setting or community. Anne and her clients identify strengths and build new skills to utilize effective strategies for responding to individuals needs. Parents, spouses, and family members may play a role in the treatment process to improve family relationships, support new learning, and create new templates for behavior.

Integrated Training and Consultation
Anne Ford also provides training and consultation for health care providers, parents, employers, teachers, professionals, and spouses who are involved with individuals on the autism spectrum.  This includes information on causes, symptoms, co-morbidity, and treatments for a whole range of often co-existing neuro-behavioral disorders in individuals.  Anne and her colleagues at Partners in Healing provide autism spectrum services throughout the life span:    

•    Neuropsychological evaluations for child, teens, and adults
•    Parent support for families with someone on the spectrum
•    Marital therapy when a spouse has Asperger’s/high functioning autism
•    Psychoeducation and support for siblings of a family member on the spectrum
•    Classroom skills necessary to navigate the school and social world
•    Workforce skills necessary to navigate the work and social world, to apply knowledge to real life situations, and aid in the development of a strong work ethic.
•    Naturopathic medicine and nutritional counseling for individuals on the spectrum

Treating Co-existing Conditions
Co-morbidity often accompanies Asperger’s/high functioning autism.  Anne Ford also treats a range of concerns with cognitive-behavior therapy and EMDR:

•    Mood Disorder, Depression and Bipolar Disorder
•    Anxiety Disorders, OCD, Panic Disorder and Social Anxiety
•    Adoption and Attachment Issues
•    Trauma/PTSD
•    Strained relationships with parents and authority figures
•    Decline in academic performance
•    ADD/ADHD issues
•    Anger Management
•    Thought Disorders
•    Personality Disorders
•    Negative peers
•    Somatoform Disorders
•    Eating disorders

 

 

 

 

 

First came the stories about cognitive problems (e.g., early onset dementia) experienced by retired professional football players. Then came increased concerns about active professional athletes who suffered on-field concussions and the guess-work as to when they could return to the playing field. Next came stories about athletes under age 18 who suffered concussions, and the legitimate questions as to whether their younger brains made them more vulnerable to the effects of repeated blows to the head sustained in the course of their chosen sports. Other questions about managing concussions in young athletes abound. For example:

• Should kids be required to leave the game after their “bell is rung” or they “see stars?”
• What is the timetable for a safe return to play?
• On what basis is the decision to return to play made?

These and other questions have been raised about how to balance the benefits of participation in school sports with the need to manage the near-term and potential long-term consequences of concussion in athletes younger than 18 years of age.

Current statistics indicate that more than 140,000 youth suffer concussions each year, with approximately one third of them suffered in the course of playing organized sports. Most of the injuries occur as a result of participation in football and ice hockey, but according to a recent article in Scientific American (February 2012), soccer, wrestling and other sports, contribute their fair share to the total.

Identifying the Signs of Concussion

Concussion involves when a blunt force to the head produces altered concentration, memory, judgment, balance or coordination problems, however transient. Loss of consciousness is not a required symptom. The alteration of normal mental status, which often lasts only a short period of time, nevertheless indicates a minor traumatic brain injury has been sustained.

A neuropsychological evaluation assesses key functions that are sensitive markers of readiness to resume play:

• Attention, concentration, and vigilance
• Reaction time, divided attention, and mental flexibility
• Learning and memory abilities (verbal and non-verbal)
• Problem-solving, planning and reasoning skills

A neuropsychological evaluation of the athlete at the Institute for Brain-Behavior Integration (IBBI) carefully examines these cognitive abilities and determines whether current levels of functioning are consistent with estimates of how they have functioned in the past. IBBI uses this data to help guide subsequent treatment plans and assist in making decisions related to safe levels of activity that the athlete can be engaged in during the various phases of recovery.

Managing the After-Effects of Concussion

It is said that, “time heals all wounds.” How much time is really needed to heal the wound of concussion? In the case of pediatric concussion, several issues combine to determine the length and extent of an individual’s recovery. 1) What was the baseline functioning prior to the concussion? 2) Was this the first concussion and what was the interval of time between the current and prior concussion if there was more than one? 3) Have changes in the functions or behaviors seen in Post-Concussion Syndrome been observed? Answering these and other questions as part of the IBBI evaluation helps determine the optimal plan for each affected athlete (or for a child or adolescent who has sustained a concussion for any reason).

Clinical Collaboration is the Key to Treatment Success

Managing the after-effects of concussion is challenging because in addition to cognitive concerns, problems with sleep, emotional disturbance, somatic complaints and also changes in family and peer relationships prove to be very challenging. At IBBI we actively work with the referring team of health professionals to formulate the optimal plan of care for each patient. Our professional staff is available to address the psychological, interpersonal and behavioral issues that can arise with the patient and his/her family.

Prompt & Actionable Evaluation Findings

At IBBI, we work to schedule and evaluate patients as soon as possible after their injury. Following the evaluation process, we provide prompt results to the referring physician, which contain comprehensive and actionable recommendations that guide the student, his/her family and treating physicians in how best to manage the neuropsychological and psychological aspects of the post-concussion recovery process. Also, we remain available to consult with the physicians throughout the evaluation and treatment process.

Are Diet Soft Drinks Bad for You?

ScienceDaily (Jan. 31, 2012) — A new study finds a potential link between daily consumption of diet soft drinks and the risk of vascular events.

Individuals who drink diet soft drinks on a daily basis may be at increased risk of suffering vascular events such as stroke, heart attack, and vascular death. This is according to a new study by Hannah Gardener and her colleagues from the University of Miami Miller School of Medicine and at Columbia University Medical Center. However, in contrast, they found that regular soft drink consumption and a more moderate intake of diet soft drinks do not appear to be linked to a higher risk of vascular events. The research appears online in the Journal of General Internal Medicine published by Springer.

In the current climate of escalating obesity rates, artificially sweetened soft drinks are marketed as healthier alternatives to sugar-sweetened beverages, due to their lack of calories. However, the long-term health consequences of drinking diet soft drinks remain unclear.

Gardener and team examined the relationship between both diet and regular soft drink consumption and risk of stroke, myocardial infarction (or heart attack), and vascular death. Data were analyzed from 2,564 participants in the NIH-funded Northern Manhattan Study, which was designed to determine stroke incidence, risk factors and prognosis in a multi-ethnic urban population. The researchers looked at how often individuals drank soft drinks -- diet and regular -- and the number of vascular events that occurred over a ten-year period.

They found that those who drank diet soft drinks daily were 43 percent more likely to have suffered a vascular event than those who drank none, after taking into account pre-existing vascular conditions such as metabolic syndrome, diabetes and high blood pressure. Light diet soft drink users, i.e. those who drank between one a month and six a week, and those who chose regular soft drinks were not more likely to suffer vascular events.

Gardener concludes: "Our results suggest a potential association between daily diet soft drink consumption and vascular outcomes. However, the mechanisms by which soft drinks may affect vascular events are unclear. There is a need for further research before any conclusions can be drawn regarding the potential health consequences of diet soft drink consumption."

Brought to you by Harriet Kohen, MSW, LICSW

Routines are soothing. Think about babies and how they are wired for feeding and sleeping routines.  Routines can allow the scariness and separation of bedtime to be absorbed by predicable schedules and activities for most toddlers and school age children. Routines and rituals can mean the difference between healing sleep and hours of wakefulness.

Routines decrease anxiety and lowers resistance to regular tasks, according to Dr. Howard. Tooth brushing and taking out the trash become expected. Routines also send important messages to children and reinforce a sense of belonging. When a family experiences major stress such as a job loss or chronic illness, routines provide stability.

Family without routines tends to be chaotic. Perhaps this is due to high levels of parental stress pr depression or anxiety in a parent.

Family meals, consistent homework times, and rules about curfews tend to promote academic success and lessen behavioral problems for adolescents.

Routines also help children stay organized so they can fit in exercise, socializing and faith-based programs. They protect children feel more confident about their daily life.

Routines convey value or meaning and help to communicate to children what’s important to the family. Parents are encouraged to explain routines in a clear way especially to children who are anxious. For example, instead of saying you’ll “try” to do something, just do it or explain why it can’t be done and make alternate plans.

Routines can be simple so they can be easily repeated. If your child becomes rigid about routines, this could be a coping strategy, especially if your child is 2-7 years old. You can always visit with your pediatrician if you’re concerned.

Although rituals and routines overlap, a routine is something done the same way over and over and a ritual is a routine with symbolic value.

If you would like to consult about ways to introduce or streamline routines and rituals in your family, consider a consult with Harriet Kohen, LICSW or Anne Ford, LICSW at Partners in Healing at 763-546-5797. WE CAN HELP.

*Pediatric News, November 2011.

Brought to you by Lois Fischer, MA, LMFT

If your marriage is having problems, you shouldn't wait too long to seek professional help.

From some recent reading I've done, in addition to my own experience in working with couples, I am sharing some  information on what type of couple gets the most from marriage counseling and what type of couple receives the least from marriage counseling.

Answer These Questions:

•    Did you marry at an early age?
•    Are you in an inter-faith marriage?
•    Did your parents divorce?
•    Do you criticize one another?
•    Is there a lot of defensiveness in your marriage?
•    Do you tend to withdraw from one another?
•    Do you feel contempt for one another?

If you answered "yes" to most of these questions, then you are statistically a higher risk for divorce than couples who have realistic expectations of one another and their marriage, communicate well, use conflict resolution skills, and are compatible with one another.

The Effectiveness of Marriage Counseling

A study by the American Association for Marriage and Family Therapy (AAMFT) shows that families do want therapy and place a high value on the experience.

What Type of Couple Gets the Most From Marriage Counseling?
Answer:

•    Young couples.
•    Non-sexist couples.
•    Couples who are still in love.
•    Couples who are open to therapy and change.

What Type of Couple Receives the Least from Marriage Counseling?

Answer:
•    Couples who wait too long before seeking help.
•    Marriages with one or the other spouse set on getting a divorce.
•    Married individuals who are closed to any suggestions that may save the marriage.

Solutions Learned From Happy Couples

Dr. John Gottman's research looks at happy couples for solutions. He has discovered that even though all couples experience conflict in their marriages, happy couples apparently know how to handle their disagreements because of a foundation of affection and friendship.

Unhappy couples do not have this skill.

Gottman's research suggests that the goal of couple therapy needs to change. Rather than trying to change marriages, he thinks counselors should teach communication skills to couples.

Don't Wait
If you think your marriage is in trouble, do not wait.  Call Lois Fischer for an appointment at 763-546-5797 and get your relationship back on track.  

Brought to you by Dr. Alana Riss Fine

I work closely with people who are working on significant weight loss, with and without gastric bypass surgery.  Have you noticed how closely our emotions are tied to food?  I was recently on WCCO Radio offering tips about how to avoid emotional eating at the holidays and throughout the year.  It's very helpful to keep a food log on paper, on your phone, or online.  Multiple studies have found that keeping a log helps people to learn to be mindful of their food intake.  Here's the interview.  Need more help?  Come see me at Partner in Healing of Minneapolis at 763-546-5797. 

Michele Tafoya Show - Avoid Emotional Eating at the Holidays