kaap--integrative medicine evaluation and treatment of ...€¦ · 4/10/2015 1 integrative medicine...

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INTEGRATIVE MEDICINE EVALUATION ANDTREATMENT OF COMMON PEDIATRIC DISORDERS

Anna Esparham, MD, FAAPandJoy Weydert, MD, FAAP

University of Kansas—Departments of Pediatrics and Integrative Medicine

DISCLOSURE

• We have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity

• We do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

WHAT IS INTEGRATIVE MEDICINE?

Personalized medical therapy and treatment of chronic disease that embraces conventional and complementary therapies.

Integrative medicine reaffirms the importance of the therapeutic relationship, a focus on the whole person, lifestyle, biochemical (metabolic) individuality and environmental influences.

Specific emphasis on “Food as Medicine” and “Developing Resilience”

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WHAT DO THESE HAVE IN COMMON?

Eczema

PCOS

Migraines

ADHD

Frequently seen in pediatrics Increasing incidence Often not improved with

conventional interventions/medications despite your best efforts

They share similar underlying pathophysiologythat contributes to their manifestations

USUAL SEQUENCE OF EVENTS

Conventional medical treatments are prescribed to manage the symptoms that present

When symptom management fails, we do more investigations and try different medications

When that doesn’t work, we refer to sub-specialists

When that doesn’t work we send them to psychiatrist/psychologist

TODAY’S OBJECTIVES

Understand the shared underlying mechanisms that contribute to common pediatric disorders

Appreciate the role that healthy nutrition and nutritional supplements play in the treatment of these disorders

Learn of other evidence-based integrative medicine therapies used in these disorders

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INTERACTIONS OF NEURO-ENDO-IMMUNESYSTEMS

Immune system Endocrine system(neutrophils, autoantibodies, TNF‐α, GALT, etc) (ACTH/cortisol, estrogen, CRH, Vitamin D, etc)

Neurotransmitters/Nervous system

(substance P, glutamate, aspartate, serotonin, etc)

LEAKY GUT SYNDROME/INTESTINAL

PERMEABILITY

Bischoff SC. “Gut health”: a new objective in medicine? BMC Med. 2011; 9: 24.

Expected gut floraBacteriaBeneficial bacteriaYeast

GUT MICROBIOME

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GUT MICROBIOME

Microbiota-gut-brain axis Altered gut microbiota

Enteric Health and Disease

Immune dysfunction Pediatric atopic disorders

Nervous system Neurotransmitter synthesis and metabolism Enteroendocrine System

Nutrition and Obesity Microbiota metabolites: SCFA, Vitamin K Metabolism

Urogenital Health

MH Hsieh. Semin Reprod Med 2014; 32:23-27

TOXIC STRESS

ATOPIC DERMATITIS (ECZEMA) Genetic risk factors Prenatal/Perinatal Nutrition

maternal diet/lifestyle antibiotic use type of delivery breastfeeding

Diet—abnormal EFA metabolism Skin Barrier

Decreased cathelicidins and beta-defensins in skin

Skin irritants and allergens Immune Dysregulation

Increased levels of cytokines and chemokines TH-1:Th-2 imbalance IgE autoreactivity

MicrobiomeBoguniewicz M & Leung DY. Immunol Rev. 2011; 242(1): 233-46Peroni DG et al. Ital J Pediatrics 2012, 38:22

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ATOPIC DERMATITIS: DIETARY ASSESSMENT

Food Sensitivity or Food Allergy? Diagnosis for Food Sensitivity:

Elimination Diet with food challenge is gold standard IgG/IgA food panel controversial

Diagnosis for Food Allergy: Skinprick Testing, IgE RAST Gold standard is elimination diet with food challenge

Bergmann MM et al. J Allergy Clin Immunol: In Practice 2013; 1:22-8


Fatty Acids

Evaluate for fatty acid imbalance: Dietary Intake Serum Comprehensive Fatty Acid Panel RBC Fatty Acid Profile

FA Patterns in Atopic Dermatitis Low Gamma-Linolenic Acid Levels1,2

Found in evening primrose oil/borage oil Omega-3 Fatty Acids may reduce risk3

1. Simon D et al. Adv Ther. 2014. doi: 10.1007/s12325-014-0093-02. Foolad N. et al. JAMA Dermatol. 2013; 149(3): 350-53. Saadeh D et al. Nutrients. 2013; 5(9): 3399-3423


Zinc—Necessary for Skin Healing Zinc levels lower in children with AD than controls1,

2, 3, 4

Evaluate Dietary Sufficiency Serum Zinc Levels

Zinc Repletion Children 2-12 yo: 10-50 mg daily Adults: 25-100 mg daily

1. Kim J et al. Acta dermato-venereologica. 2014; 94(5): 558-622. Toyran M et al. J Investig Allergol Clin Immunolog. 2012; 22:341-443. David TJ et al. Br J Dermatol. 1990; 122: 485-4894. David TJ et al. Br J Dermatol 198; 111: 597-601

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ZINC FOOD SOURCES

Zinc Food sources from: www.whfoods.com

Serum Zinc Levels:

Dietary Adequacy: Is the patient meeting 100% of their needs?


Vitamin D—ideal 25 OH-D level of 50-80 ng/ml Vitamin D deficiency increases the risk of sensitization to food

allergens and the severity of atopic dermatitis

Children given 4000 IU daily for 21 days Significant in cathelicidin levels Reduced colonization of skin pathogens.

Supplementation with 1,000 IU daily increased 25 OH-D levels, reduced AD severity, and reduced serum cytokine levels Normalization of Th-1 and Th-2 interleukin serum patterns

Baek, et al. J Pediatr. 2014;165(4):849-854.Hata. Allergy Clin Immunol. 2008;122(4):829-831Di Filippo, et al. Int Arch Allergy Immunol. 2015;166(2):91-96.

ATOPIC DERMATITIS: INTEGRATIVE MEDICINE TREATMENT

Determine food allergy(IgE) or sensitivity(IgG) Wheat, dairy, corn, soy, eggs, nuts

[Wang J. J Clin Invest. 2011 Mar 1;121(3):827-35.]

Treat intestinal yeast overgrowth/colonization [Lintu P, et al. Allergy 2001,56:512-517] [Yamaguchi N et al. Gut. 2006 Jul;55(7):954-60]

Probiotics [Abrahamsson TR, et. al. J Allergy Clin Immunol. 2007;119(5):1174-80.] [Wang IJ. Clin Exp Allergy. 2015 Jan 20. doi: 10.1111/cea.12489. ]

Supplement with EFA 1-2 grams/day if indicated Both Omega 3 and Omega 6

[Skellchock LE. Integrative Medicine,2nd ed. Saunders 2007, Philadelphia, PA.]

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Supplement with Zinc and Vitamin C [Kim JE. Acta Derm Venereol. 2014 Sep;94(5):558-562. ]

Increase Vitamin D [Di Filippo. Int Arch Allergy Immunol. 2015;166(2):91-96.]

Bathe in warm water with 1-2 cups baking soda or sea salt Tea Tree essential oil 5% body wash to irradicate MRSA

[Dryden MS. J Hosp Infect. 2004 Apr;56(4):283-6.]

Use coconut or olive oil topically [Verallo-Rowell VM. Dermatitis. 2008 Nov-Dec;19(6):308-15.]


Mind-Body Techniques Hypnosis

[Adinolfi B. Acta Biomed. 2013 Sep 1;84(2):94-97]

Progressive muscle relaxation [Bae BG. Acta Derm Venereol. 2012 Jan;92(1):57-61]

Kissing [Kimata H. J Psychosom Res. 2006 May;60(5):545-547]

Chinese Herbal Medicine [Chen HY. Evid Based Complement Alternat Med. 2015;2015:347164]

Acupressure [Lee KC. Acupunct Med. 2012 Mar;30(1):8-11]

POLYCYSTIC OVARIAN SYNDROME: ETIOLOGYKey contributors to pathogenesis:• Chronic low-grade

INFLAMMATION• Metabolism

• Food & Nutrition• Physical Activity

• Endocrine Disruptors

Adolescent PCOS:Insulin resistanceHyperinsulinemiaObesityMetabolic syndromeSleep disorders

Johnsson J & Stener-Victorin E. Evid Comp Altern Med. 2013Barrett ES & Sobolewski M. Semin Reprod Med. 2014; 32(3): 166-76

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PCOS: DIETARY THERAPY

Dietary Therapy1

Anti-inflammatory diet Low glycemic index/load Grain-free Ketogenic Diet2

1. Liepa et al. Nutrition in Clinical Practice. 2008; 23(1): 63-712. Mavropoulos JC et al. Nutr Metab. 2005;2: 35

PCOS: VITAMIN D

Vitamin D =

Secosteroid

Not just a mediator of “calcium

homeostasis”

Immunomodulatory

Antimicrobial Antiproliferative

Mediator in Chronic Disease

Metabolism & Glucose Homeostasis1

•Upregulates insulin gene transcription

•Improves insulin secretion and glucose tolerance

•Activates PPAR-δ – a transcription factor implicated in regulation of fatty acid metabolism

1. N El-Fakhri et al. Hormone Research in Paediatrics. 2014

PCOS: DIETARY ASSESSMENT

Vitamin D Low blood levels of serum 25 (OH)D Intervention studies improved androgen profiles, blood

pressure, glucose metabolism and menstrual frequency

Treatment: Follow US Endocrine Society Guidelines Maintain Vit D levels between 40-60 ng/ml

Pal L et al. Gynecol Endocrinol. 2012;28:965-968Wehr E et al. J Endocrinol Invest 201;34: 757-763

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Omega 3 Fatty Acids Imbalance of n-6/n-3 fatty acids results in

inflammation 8-week supplementation with 720 mg EPA & 480

mg DHA/day improved insulin resistance, lipid profiles, and adiponectin levels in overweight PCOS patients

Treatment: 1-2 grams of Omega-3 fatty acids daily with meal

Rafraf M et al. J AM Coll Nutr. 2012;31:361-368


Chromium picolinate Increases insulin sensitivity and decreases fasting blood

glucose compared to metformin in clomiphene citrate-resistant patients1

Treatment: 200-1000 mcg daily2

1. Amooee S. et al. Iran J Reprod Med. 2013; 11(8): 611-18

2. Chromium. Natural Medicines Comprehensive Database. Nov 2014.

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ACUPUNCTURE/ACUPRESSURE

PCOS: INTEGRATIVE MEDICINE TREATMENT

Supplement with Vitamin D, O-3, Zinc (if copper is high), Chromium picolinate

Lifestyle Modification 5-10% weight loss

[Moran LJ et al. Cochrane Database Syst Rev 2011;7:CD007506]

D-Chiro-Inositol or Myo-Inositol Improves menstrual cycle regularity, Acne score, endocrine and insulin

resistance profiles in young overweight PCOS patients [Formuso C et al. Minerva Ginecol 2015 Feb 11 [Epub ahead of print]

N-acetylcysteine or liposomal glutathione NAC improved pregnancy and ovulation rates compared to placebo

[Thakker D et al. Obstet Gynecol Int 2015; 817849]

PCOS: INTEGRATIVE MEDICINE TREATMENT

Acupuncture/TCM Improved ovulation frequency in acupuncture group compared to

physical therapy [Johansson J et al. Am J physiol Endocrin Metab. 2013; 304(9):E934-43]

Mindfulness Mindfulness based stress management program revealed significant

reductions in stress, depression, anxiety symptoms and salivary cortisol in women with PCOS

[Stefanki C et al. Stress. 2015; 18(1): 57-66]

Yoga A holistic 12-week yoga program improved AMH, LH, testosterone

levels, hirsutism, and regulated menstrual frequency [Nidhi R et al. J Altern Complement Med. 2013; 19(2):153-60]

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MIGRAINE/HEADACHES

Migraine attacks are result of inflammationat level of trigeminovascularconnections1

Mitochondrial dysfunction2

Hormonal Imbalance/Menstrual Disorders3

Dysfunctional stress response4

Diet & Nutrition5

Majority are myofascial May not have “body

awareness” of muscle tension/stress

History often reveals multiple traumas Physical, emotional,

repeated illnesses These affect body

mechanics and nerve function

PE often reveals myofascial restrictions or trigger points

1. Akerman S et al. Nat Rev Neurosc. 2011; 12(10): 570-842. Yorns WR & Hardison HH. Seminars in Ped Neurol. 2013;20(3): 188-933. Hassan S et al. Pain. 2014. doi: 10.1016/j.pain.2014.08.0274. Parashar R et al. Int J Womens Health. 2014 24;6: 921-55. Finkel A et al. Current Pain Headache Reports. 2013; 17(11): 373

MIGRAINE:DIETARY ASSESSMENT

IgG food sensitivity testing [Aydinlar E . Headache. 2013 Mar;53(3):514-525. ]

Recognizing food triggers (food diary) or possible hypoglycemia

[Finocchi C. Neurol Sci. 2012 May;33 Suppl 1:S77-80.]

Food additives (i.e. MSG) Preservatives Chemicals

[Finkel A. Current Pain Headache Reports. 2013; 17(11): 373


Magnesium—RBC vs serum 98% of magnesium works intracellularly RBC magnesium levels lower in those with migraine compared

to controls [Mazzotta G. Cephalalgia. 1999 Nov;19(9):802-809.]

Serum level may be “normal”, but still be deficient

[Orr S Cephalalgia. 2014; 34(8): 568-583]

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MAGNESIUM REPLETION

Magnesium Malate/Glycinate/Taurate/Citrate Most commonly used forms of Magnesium due to less

gastrointestinal side effects (Oxide causes diarrhea)

Dosage: Children 2-12 yo: titrate up to 6 mg/kg/day or 50-600 mg Adolescents and Adults: 350-750 mg


Vitamin D Serum vitamin D and VDR levels were found to be significantly

lower in migraine patients than in controls [Celikbilek A. Int J Clin Pract. 2014 Oct;68(10):1272-1277]

vitamin D experts suggested 25 OH-D levels above 30 ng/ml as a target

[Pramyothin P Curr Opin Gastroenterol. 2012.28(2):139-150]

Each 100 IU raises the 25OHD levels by 1 ng/ml

Ref. Range 2/5/2013 8/13/2013 3/19/2015

Vitamin D(25-OH)Total 30-80 NG/ML 22 (L) 27.9 (L) 24.2 (L)

VITAMIN D REPLETION

US Endocrine Society's Clinical Practice Guideline Vitamin D-3 400-1,000 IU per day may be needed for children aged less

than 1 year

600-1,000 IU per day for children aged 1 year or more

1,500-2,000 IU per day for adults aged 19 years or more to maintain 25(OH)D above the optimal level of 30 ng/ml.

[Pramyothin P Curr Opin Gastroenterol. 2012.28(2):139-150]

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MIGRAINES: DIETARY ASSESSMENT

CoQ10 deficiency Low CoQ10 levels common in migraine Plasma CoQ10 (Reduced and Total)

1. Orr S and Venkateswaran S. Cephalalgia. 2014; 34(8): 568-583

COQ10 REPLETION

COQ10 Repletion 1-3 mg/kg/day in children and adolescents Most common dosage forms are between 25-300 mg Ubiquinol (Reduced CoQ10)

Hershey et al. Headache. 2007; 47: 73-80

MIGRAINE: DIETARY ASSESSMENT

Vitamin B2: Riboflavin Diagnosis of Deficiency:

Red blood cell glutathione reductase activity24-hr urine riboflavin excretion of less than 10%RBC riboflavinSerum riboflavin

[Stipanuk MH & Caudill MA. Biochemical, Phys, & Molec Aspects Human Nutrition. 3rd ed. 2013]

Common Signs/Symptoms of Deficiency:Beefy red tongue, seborrheic dermatitis, cheilosis, and sore throat

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MIGRAINE REPLETION

Vitamin B2: Riboflavin 200-400 mg/day for migraine prophylaxis1

Riboflavin is in a B-complex [Colombo B. Neurological Sciences. 2014; 35(1): 141-144]

MIGRAINE:INTEGRATIVE MEDICINE TREATMENT

Elimination Trial, Whole Foods & Anti-Inflammatory Diet to reduce inflammation

Magnesium over the course of 16 weeks reduced migraine frequency and severity

in children [Wang F, et al Headache 2003; 43:601-10]

Co-enzyme Q10 safely reduced migraine frequency and associated disability in children

who were found on screening to have low clinical co-enzyme Q-10 values.

[Hershey AD, et al Headache 2007 47: 73-80 ]

Riboflavin (B-2) Riboflavin may be effective in migraine, with a more favourable

response in boys and in individuals with severe migraine. [Condo M.J Headache Pain 2009; 10: 361–365]


Butterbur root extract at least a 50% reduction in migraine attacks in 77% of children

aged 6-17. [Pothmann R. Headache 2005 Mar; 45(3):196-203]

Mind-Body techniques Breathing/relaxation training, biofeedback and cognitive-behavioural

therapy, stress management [Trautmann E. Cephalalgia. 2006 Dec;26(12):1411-1426]

CD-ROM program on home computers for 4 weeks had significant improvements in headache activity above and beyond those in the control group.

[Connelly M, Rapoff M, et al J Pediatr Psychol 2006;31(7):737-747]

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Diet/Sleep/Hydration/Regular meals Lifestyle factors are often primary in initiating and maintaining

headache syndromes in children [Grazzi L. Neurol Sci 2004;25(Suppl 3):S223-225]

Music Therapy music therapy was superior to placebo over 12 weeks as well

as 6 months later [Oelkers-Ax R, et al Eur J Pain. 2008 Apr;12(3):301-13.]


Acupuncture/Acupressure DBRPCT in 43 children with migraine or tension-type headache

found a significant improvement in headache-free days for children receiving “true” acupuncture with low level laser.

[Gottschling S, et al Pain 2008 Jul 15;137(2):405-12.]


Manual therapies OMT, cranio-sacral, myofascial release, massage “Hands on” helps where meds fall short Initially start with practitioner, but teach self-therapy

[Bronfort G. J Manipulative Physiol Ther. 2001;24:457-466]

Physical therapy/Yoga Therapies to improve posture Therapies for core strengthening

[Hainsworth KR. Pain Manag Nurs. 2014;15(2):490-498.]

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HEADACHE TRIGGER POINTS

HEADACHE TRIGGER POINTS

ADHD

Affects11% children ages 4-17 yo1

Increasing in prevalence

Etiology Genetics Nutritional status Oxidative stress Neurotransmitter/endocrine dysregulation Neurologic abnormalities (fronto-striatal and basal

ganglia network) Physical & emotional trauma Environmental toxicity Modern Media

1. Centers for Disease Control and Prevention (2013): Attention-Deficit/Hyperactivity Disorder. Available online: http://www.cdc.gov/ncbddd/adhd/data.html

2. Esparham et al. Children. 2014

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INTEGRATIVE RX FOR ADHD

Dietary therapies Micronutrients Probiotics/Gut Microbiome Neurofeedback Biologic-based Therapies Mind-Body Therapies HBOT Pet therapy Music therapy

Harrington J and Allen K. Pediatrics in Review. 2014, 35(2): 62-78

ENVIRONMENTAL EXPOSURES RISK OFNEUROPSYCHIATRIC DISORDERS

Children are vulnerable to environmental toxins Organochlorines: DDT, PCBs Organophosphates: pesticides Plastics: BPA & Phthalates Lead

Gilbert SG et al. J Intellect Dev Disabil. 2010; 35, 121-128Aguiar A et al. Environ Health Perspect 2010; 118:1646-1653Sagiv SK et al. Am J Epidemiool. 2010; 171:593-601

TAKE A GOOD ENVIRONMENTAL EXPOSUREHISTORY BESIDES JUST LEAD

Ask patient’s family and family’s parents Do you use weed-killers? Pesticides/insecticides or have an exterminator? Live near farms that spray? Well water? Use of plastics in microwave? Use of fragrances, lotions, makeup that contain BPA, phthalates,

parabens?

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WHY DIETARY THERAPY?

Greater prevalence of GI symptoms among children with ADHD1

Hypothesis: gut-brain axis dysfunction in neuropsychiatric disorders 90% neurotransmitter synthesis in gut2

~66-75% immune system in gut3

1. McKeown C et al. Pediatrics. 2013 Nov; 132(5): e1210-5.2. Gershon MD. Hosp Pract. 1999;34(7)31-23. Weiner HL et al. Immunol. Rev. 201, 241(1): 241-59

HOW-TO: ELIMINATION DIET

Removal of most common food allergies or sensitivities: dairy, gluten/wheat, corn, soy, eggs, citrus, tree nuts, peanuts,

and shellfish

Usually 21-96 day elimination trial and then reintroduce one food every 3-7 days

Have families note any health/physiologic changes in addition to behavioral symptoms during food challenge

ELIMINATION DIET ADHDINCA study:

Impact of Nutrition in Children with

ADHD

1st phase: Open label for individual nutrition guidance

5 Weeks

Elimination diet group or control

group

100 enrolled and randomized with 83

completing first phase and 32 eligible

for second phase

2nd Phase: Double-blind crossover

study

2 weeks

Each group assigned to three foods that

induce low IgG levels or three that induce

high IgG levels

IgE food allergies also consideredPelsser, L.M et al. Lancet 2011, 377, 494–503.

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ELIMINATION DIET: RESULTS

32 (64%) of 50 children showed significant improvement in ADHD symptoms

64% relapsed after food challenge Food IgG panel did not predict deleterious behavior

IgE allergens same in both group-> meaning there may be a food sensitivity component that was not detected by IgG

ELIMINATION DIET:RISK OF NUTRIENT INSUFFICIENCIES

Restricted Diet may result in: Weight Loss Potential insufficiencies: Protein, Vitamin D, Calcium, folate,

Iron

Strategy to avoid complications Utilize and Review Diet Diaries (e.g. written or Mobile Apps) to

review caloric intake Consult Dietitian Supplementation with laboratory guidance during elimination

diet

Dosman C et al. Pediatrics in Review. 2013; 34(10):336-41

Sugar dysregulates neurotransmission, similar to drug addiction

Majority of studies done1,2

Comparing sugar to placebo of aspartame or saccharin.

No evaluation of chronic sugar consumption

1. Wender EH & Solanto MV .Pediatrics. 1991, 88:960-66.2. Wolraich ML et al. JAMA . 1995; 4: 1617-21

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WHOLE FOODS = HEALTH

MAKE IT SIMPLE:

Healthy fat

Healthy protein

Complex carbs at every meal

ADHD:DIETARY ASSESSMENT

Iron Low ferritin and abnormal iron indices

Sleep disturbance in children with ADHD1

Intake in ADHD is lower on medication2

Brain iron is lower in striata and thalamus of children with ADHD3

1. Cortese et al. Eur child adolesc psychiatry 20092. Abou-Khadra MK et al. BMC Pediatr 20133. Adisetiyo V et al. Radiology. 2014

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IRON THERAPY

Serum ferritin <50 ng/mL with sleep disturbance + adhd/autism:

Children six years and older: Elemental iron 45-65 mg (1-2 times daily)

Children six years and younger: 3-6 mg/kg/day of elemental iron Max 150 mg elemental iron per day

Take with Vitamin C to enhance absorption


Zinc Systematic Review1:

3 out of 80 trials met inclusion criteria Conclusion:

Zinc combined with methylphenidate improved total ADHD score2

Zinc alone decreased hyperactivity and impulsivity, but no effect on inattention3

Zinc did not have any effect on ADHD symptoms, but were able to lower amphetamine medication.4

1. Ghanizadeh A & Berk M. Eur J Clinic Nutrition. 2013; 67(1):122-42. Akhondzadeh S, Mohammadi MR, Khademi M. BMC Psychiatry 2004; 4:9.3. Bilici M et al. Prog Neuropsychopharmacol Biol Psychiatry 2004; 28: 181–1904. Arnold LE et al. J Child Adolesc Psychopharmacol 2011; 21: 1–19.


Healthy Fats Several RCT differ in conclusions1,2,3,4

Due to different doses and combinations of PUFA mixes (ALA/LA/EPA/DHA/GLA)

Varying placebos with nutritional properties

Meta-analysis5

Omega-3’s are 40% as effective as methylphenidate

1. Gustafsson, P.A. et al.. Acta Paediatr. 2010, 99, 1540–1549. 2. . Milte, C.M. et al. Nutrition 2012, 28, 670–677. 3. Widenhorn-Muller, K. et l. Prostaglandins Leukot. Essent. Fatty Acids 2014, 91, 49–60. 4. Stevens, L.; et al. Lipids 2003, 38, 1007–1021. 5.Bloch, M.H.; Qawasami, A.. J. Am. Acad. Child Adolesc. Psychiatry 2011, 50, 991–1000.

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FAT FOR THE BRAIN

If not getting enough of fatty acids in diet: suggest dietary changes and supplementation with

balanced omega oil: 3/6/9 plus Phospholipids

(phosphatidylcholine/phosphatidylserine)

EEG-BASED BIOFEEDBACK (NEUROFEEDBACK)

The American Academy of Pediatrics (AAP) recently declared “biofeedback” to be an evidence-based child and adolescent psychosocial intervention with “level 1, best support”.

“Biofeedback” is used to refer to feedback interventions to train either the brain (ie, NF) or the body (traditionally referred to as biofeedback).

Neurofeedback: EEG-based form of biofeedback emphasizes:Positive reinforcement and operant conditioningRetrains abnormal brain wave states back to its normal state

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ADHD: BRAINWAVE VARIANTS

Elevated Theta/Beta Ratio Assessment of responders vs non-responders Dysregulation of slow cortical potentials

Gevensleben H et al. Brain Topogr. 2013

ADHD NEUROFEEDBACK:RESEARCH REVIEW

Meta-Analysis 2012-2014: 3 out of 12 studies included

1. NF significantly improves ADHD total score on parent scale(-0.49)

2. NF improves both inattention and hyperactivity/impulsivity dimensions on parent scale (-0.46 and -0.34)

3. NF improves inattention on teacher scale (-0.30)

Micoulaud-Franchi JA et al. frontiers in human neuroscience. Nov 2014, 8: 1-7

ADHD:INTEGRATIVE MEDICINE TREATMENT

Eliminate Food additives/preservatives/food allergens Food coloring, mercury, high-fructose corn syrup, lead

Connolly A, Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2010 Apr;27(4):447-56.

Dufault R, Behav Brain Funct. 2009 Oct 27;5:44

Whole food diet/phytonutients Curtis LT, J Altern Complement Med. 2008 Jan-Feb;14(1):79-85.

Omega 3 fatty acids Huss M, et.al. Lipids Health Dis. 2010 Sep 24;9:105. Bloch M. J Am Acd Child Adolesc Psychiatry, 2011.

doi:10.1016/j.jaac.2011.06.008

Zinc supplementation Dodig-Curković K, et.al. Acta Med Croatica. 2009 Oct;63(4):307-13.

L-theanine 100-200 mg twice a day [Cross DR, et.al.Child Care Health Dev. 2010 Dec 20. doi: 10.1111/j.1365-

2214.2010.01193.x.]

Pycnogenol 1 mg/kg (30-300mg)daily Viktorinova A, Biomed Pharmacother. 2009 doi:10.1016/j.biopha.2009.04.040

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ADHD:INTEGRATIVE MEDICINE TREATMENT

Evaluate for intestinal dysbiosis/yeast overgrowth [Bradstreet JJ, Altern Med Rev. 2010 Apr;15(1):15-32]

Sleep hygiene [Gruber R, Sleep. 2011 Mar 1;34(3):315-23.]

EEG Neurofeedback [Lansbergen MM, J Neural Transm. 2011 Feb;118(2):275-84.]

Skill building tools for stress/depression/anxiety (Parent-child interaction therapy--PCIT)

[Matos M, Fam Process. 2009 Jun;48(2):232-52.]

RESOURCES LABORATORY ASSESSMENT OF

NUTRITION

RESOURCES FOR NUTRITIONAL

MANAGEMENT OF COMMON DISORDERS

kaap--integrative medicine evaluation and treatment of ...€¦ · 4/10/2015 1 integrative medicine...

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