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March 7, 2019

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What’s in your Treatment Pie?

Mental health disorders are on the rise, and consequently, so are medication prescriptions.  Polypharm, the prescription of multiple medications, is rampant, as doctors and parents scramble to mitigate the distressing symptoms they witness in their patients and children.  This is especially problematic in the United States, where the rates are nearly double that of other Westernized countries. Zito says, “Concomitant drug use applied to 19.2% of US youth, which was more than double the Dutch use and three times that of German youth.” (Zito, 2008. Child and Adolescent Psychiatric and Mental Health.)  Increases in polypharm manifests concerning side effects, and can be quite debilitating to patients.  Many doctors, clinicians and parents are seeking to expand their “treatment pie,” by utilizing a diverse toolbox for treatment beyond that of medication.

The US is distinct in that prescribing psychotropics medications to young people often is the first line treatment for mental health concerns.  When the first medication is not effective, the next move is to add an additional medication in hopes of some amelioration. Let’s take the example of ADHD psychostimulant medications such as; Ritalin, Adderall, Vyvanse, Concerta, and Focalin. A child is struggling in school- unable to complete their school work, acting impulsively, and seemingly ignoring school rules. Doctors too often resort immediately to medications, and in turn, psychostimulants have the common side effects of suppressing appetite, inhibiting growth, increasing heart rate, causing anxiety, and contributing to sleep issues.  When these side effects occur, doctors will often add another medication to help these symptoms. This is what we call polypharmacy; the simultaneous use of multiple drugs by a single patient, for one or more conditions. This is a slippery and dangerous slope.

A recent study, the Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study (MTA Study) examined the efficacy of stimulant medication. The study initially showed promising conclusions, which were widely shared and used as a justification for increased production of stimulants and marketing by pharmaceutical companies.  Looking more closely into the MTA longitudinal follow up studies, it was the concluded that longitudinal data did not support the use of stimulants.  At the National Association of Therapeutic Schools and Programs (NATSAP) conference in January 2019, Keynote Speaker, Dr. Robert Foltz, presented on “Psychotropic Medications in Youth: Challenging the Assumptions that Guide this Practice.” And demonstrated the lack of longitudinal safety and efficacy studies for the most commonly prescribed psychotropic medications. “We had thoughts that children medicated longer would have better outcomes. That didn’t happen. There were no beneficial effects, none. In the short term, medication will help the child behave better, in the long run it won’t. And that information should be made clear to parents.” The MTA findings only support the short term (12 weeks) use of medication treatment, as there was a scarcity of data beyond that time frame. (Foltz 2019).

Dr. Britta Zimmer recently presented at the Hawaii Syncopate Doc Talks conference for physicians, and focused on the management of patients prescribed multiple psychotropic medications and how to discern medical necessity and improve safety within an outdoor behavioral treatment program. Dr. Zimmer did this with a series of case discussions while speaking to over 200 physicians on the topic. The core of the issue is that our children need an expanded scope, treatment providers who are willing to look beyond the use of polypharm psychotropics.  As an Naturopathic Physician and Medical Director of one of the leading Integrative Psychiatric programs in the country, Dr. Zimmer suggest that doctors and parents examine their “treatment pie,” a range of treatments for enhancing mental wellbeing.  Examples include improving nutrition, exercise, sleep, relationships, and mental/emotional health. A successful treatment plan is the sum of the parts of a whole. Britta Zimmer, ND, encourages people to read the MTA study and to diversify their treatment pie.

June 17, 2014

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An Integrated Approach to Sleep Disturbances

By Dr. Britta Zimmer, Medical Director

Thirty percent of children and adolescents experience some sort of sleep disturbances. Sleep disorders include insufficient sleep, insomnia, sleep apnea, circadian rhythm disorder, bedwetting, sleepwalking, restless legs and narcolepsy. Insomnia is defined as the prolonged inability to get the amount of sleep you as an individual, need to wake feeling rested. We often use this term (insomnia) loosely when describing a poor night’s rest.

Teenagers need an average of 9.25 hours of sleep every night. The fact is, you can do everything right for your health in terms of eating well and exercising, but if your sleep is dysregulated then you cannot achieve optimal health. With proper sleep, our memory is well consolidated, our immune systems are strong and our neuroendocrine systems are balanced.

Sleep is one of the Pillars of Health at Pacific Quest. We evaluate sleep quality for all adolescents and young adults in our care as part of our integrated approach to wellness. Though sleep disturbances are common for incoming Pacific Quest students, many do not consider sleep when making a connection to their overall health and well-being.  At Pacific Quest, we help young people to gain a greater sense of awareness around the importance of quality sleep. This awareness, coupled with the structure of the program help to restore quality sleep for many of our students.

Poor sleep can cause a variety of symptoms including: Mood swings, irritability, fatigue, inattention, hyperactivity, depression, impulse control problems, low tolerance for frustration, learning problems, behavioral problems, cardiovascular issues, adverse metabolic effects, hormonal imbalance, headaches, hypoglycemia, and anxiety.  Many of these symptoms mimic or are a symptom of other disorders and can be addressed with sleep restoration.

Many people experience sleep disturbance related to “cognitive popcorn”.  This refers to when you wake up in the middle of the night and cannot go back to sleep because your mind is racing. This is a common complaint I hear from the Pacific Quest students.

How to address sleep issues:

1.   Practice proper sleep hygiene

  • Sleep in a dark environment. Even the light from your cell phone can disturb melatonin secretion. Melatonin is a hormone needed for adequate sleep and an important antioxidant. It gets secreted most efficiently in the complete dark.

  • Avoid stimulants such as caffeine, chocolate, nicotine and alcohol within 4 hours of bedtime. I have had some patients who need to give up coffee completely (to their dismay) in order to fully correct their sleep disturbances. It can take up to 2 weeks of strict caffeine avoidance to correct a sleep disturbance.

  • Designate your bed and bedroom for sleep only. Watching TV or working on your computer in bed will disrupt your sleep.

  • Avoid napping during the day.  This can disturb your circadian rhythm.

  • Exercise. Leave the vigorous exercise for the morning hours and more restorative types of exercise for the afternoon.

  • Establish a regular bedtime and “wind down” routine. Going to sleep and waking up at the same time every day (including the weekends) will restore your natural sleep rhythms.

  • Do not eat a big meal right before bed. Having said that, I have used a protein snack to help sleep disturbances as this can balance the blood sugar levels throughout the night.

  • Expose yourself to natural light daily. This helps maintain a healthy sleep-wake cycle

  • Establish a nighttime ritual that does not include electronics.  Sip tea, do some light stretching, or journaling.

2.   Ditch the sleeping pills

  • NIH produced a meta-analysis finding that most sleeping pills create amnesia for awakenings and poor sleep. So you think you are sleeping well but really you are not experiencing restorative rest.
  • Sleeping pills can disrupt your memory formation and cause daytime sedation.
  • Consult your doctor before discontinuing any medications.

  • There are natural alternatives that can be used in place of sleeping pills.

3.   Learn mind-body techniques to induce sleep

  • Progressive Muscle Relaxation

  • Breathing Exercises

  • Visualization Techniques

4.   Treat the underlying causes

  • Uncover underlying issues such as hormone imbalance, anemia, hypoglycemia or thyroid disorders.

  • Evaluate medication side effects. Medications for the following medical issues have insomnia as a common side effect: pain medications, thyroid, asthma, depression,  high blood pressure, and cold/allergy medications.

  • Treat your sleep disturbance with non-toxic substances like melatonin, magnesium, chamomile, L-theanine, passion flower, GABA, and 5-HTP.

If you dread the night time because you consider yourself a “bad sleeper” or have labeled your child as a bad sleeper, create a new story with the above plan. Too often people accept poor sleep habits as part of their normal routine.

The integrative team at Pacific Quest recognizes the essential importance of restful sleep for optimal health.  We take a proactive integrative approach to sleep issues and with knowledge and insight, you can too. Sweet Dreams…

October 11, 2013

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The Importance of Nutrition in Mental Health

By Dr. Britta Zimmer, Medical Director

It is time to face a simple fact and reclaim health:

Nutritious Food is Medicine

harvestIt’s easy to get caught up in the complexity of science, research, and the physiology of the human body, therefore I am constantly reminding myself, my patients, and my patients’ parents to get back to the roots because without being rooted, healthy change and growth are difficult to obtain.

The roots of health and healing are simply:

good nutrition, adequate sleep, daily movement, and stress management. These are Pacific Quest’s pillars of health. These roots are simply based in science and research.

I just attended The Integrative Medicine for Mental Health Conference and was reminded (via extensive research and excellent lectures) of the importance of nutritional interventions in the treatment of AD(H)D,  Depression, Anxiety Disorder, Obsessive Compulsive Disorder, Eating Disorders, Bipolar Disorders, and Autism Spectrum Disorders.

Question:

Why is proper nutrition critical in the treatment of all mental health disorders?

Answer:

Psychotropic medications, such as Prozac, Abilify, Wellbutrin, Seroquel, Ritalin to name a few, affect levels of neurotransmitters in the brain, however these neurotransmitters are controlled by chemical precursors which are made in the body from nutrients obtained from our diet.

Translation:

Without the proper nutrients the neurotransmitters that psychiatric medications target such as serotonin, norepinephrine, and dopamine cannot be made or balanced in the first place.

Solutions:

Solution #1

Eat adequate protein in every meal, protein is made up of amino acids and which are precursors to neurotransmitters.

How much protein?  Recommended daily protein  intake is 1 gram per kilogram of body weight. (Example: 115lbs  =  52.2 kg  =  52 gram protein- If you exercise more than 6 hours weekly  =  2 grams per 1 kg of weight)

Be aware that vegetarian diets, antacids, stress, and poor digestive function all inhibit the body’s absorption of protein.

Protein Warning: talk to your doctor if you have kidney disease

Solution #2

Eat foods high in the following vitamins and minerals (or supplement your diet with these nutrients);

B-complex with folate, B6 and B12, Zinc, and Magnesium. These nutrients are essential for neurotransmitter production. You can Google search foods which contain high amounts of these nutrients.

Solution #3

Take Omega 3 Fatty Acids in the form of Fish Oil.

Truthfully, we should be bathing our brains in omega 3 fatty acids. Every aspect of neurotransmission involves the adequate functioning of omega 3 fatty acids in your body. Also research demonstrates the link between depression and inflammation; levels of omega 3 fatty acids in the body directly influence the body’s inflammatory response.

Take reputable brands of Fish Oil such as Nordic Naturals, Carlsons, Pure Encapsulations, or Vital Nutrients as these companies conduct stringent testing for their products. Fish oil sold at Costco and Trader Joe’s has not been adequately tested for potency and purity, I do not recommend those brands

If you take the good brands mentioned above you will NOT burp up fish oil or taste anything “fishy” as these are high quality ingredients.

Vegetarian sources of Omega 3 fatty acids such as flax oil have not been proven to decrease inflammation and support neurotransmitter production like fish sources.

Fish Oil Warning: talk to you doctor if you take blood thinners, do not take fish oil prior to surgery

Solution #4

Test for food IgG allergies and avoid these foods.

Most common IgG food reactions: Gluten (wheat, barley, rye, spelt), Casein (milk products), Eggs, Baking yeast, Citrus, Peanuts, Corn, Sugar, and Soy.

You can test these via eliminations diets or an IgG blood test. The IgE skin prick tests commonly offered by allergist do not give you this information.

Studies show the correlation between gluten consumption and the increase in symptoms related to depression, autism, anxiety, and AD(H)D.

Gluten and casein can increase inflammation in the body, create an autoimmune response, cause gastrointestinal damage, and create an opiate response. This potential opiate response is partly responsible for the addictive quality of certain foods such as pizza, mac n’ cheese, and chicken nuggets. Usually if it is a food you claim that you “absolutely cannot and will not give up” then you most likely have a food sensitivity to that food- sad but true.

Parents are the biggest obstacle to instigating a gluten and casein free diet because it is too much work for them, they do not see the value in it because they don’t wait long enough to keep their child off of gluten/casein, they allow their child cheat “because they feel bad for them” or they succumb to their child’s demands. It takes at least 4 weeks of strict gluten and casein avoidance to see the positive results. Once the patient experiences a reduction of symptoms with a gluten and casein-free diet this motivates them further to avoid these foods. This is the key to adolescent and young adult compliance to restrictive diets, they have to experience first hand the improvement.

Not mentioned in the 4 solutions above is the importance of Vitamin D in the treatment of mental health disorders, more about that in blogs to come.

All neurological conditions are whole body disorders,  because the body/brain are connected (literally and biochemically. )One must treat the whole body to treat neurological disorders such as AD(H)D, Depression, Anxiety Disorder, Obsessive Compulsive Disorder, Eating Disorders, Bipolar Disorders, and Autism Spectrum Disorders.

The cornerstone of whole body treatment is Nutrition.

Pacific Quest is the only therapeutic treatment programs which offers a gluten-free, casein-free, anti-inflammatory, nutrient dense, organic, whole foods diet.

References available upon request

drbz@pacificquest.org

September 8, 2012

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Pacific Quest Presents at the AANP Conference

By Britta Zimmer, ND, Medical Director

Pacific Quest Wilderness Therapy ProgramIn front of a standing room only crowd, Dr. Kasenchak and I recently presented at the American Association of Naturopathic Physicians conference in Bellevue, Washington. The audience consisting of MDs, NDs, and PhDs were eager to hear about Pacific Quest’s unique management approach to treating common mental health disorders.  The innovative and eye-catching presentation captured the audience’s attention for 90 minutes with graphics and video footage created by Pacific Quest’s own IT expert, Gig Todd.  This presentation demonstrated an integrated model of inpatient wilderness therapy for the management of common mental health disorders. The co-management options provided by Naturopathic Physician, Psychiatrist, and Psychologist were discussed. Useful therapeutic interventions as well as psycho-pharmacological therapy were detailed as they create a comprehensive therapeutic program for our patients.

Within this integrated model, Naturopathic Medical interventions have played a critical role in optimizing mental health outcomes. Dr. Kasenchak discussed the diagnostic criteria for common mental health disorders and the role that psychological testing plays in our program. Pacific Quest’s unique wellness program forms the basis of our integrated approach led by doctorate level professionals.

Pacific Quest “Defragments” Health Care Management: Our Whole Person Approach. During the medical clearance phase of the application process, I discuss the applicant’s medical history with the families. The common scenario is a child who has been evaluated by various specialists; psychologists, psychiatrists, pediatricians, neurologists, gastroenterologists and the list goes on. These adolescents and young adults are often on several different medications providing little relief to their behavioral issues or presenting complaints. There has been no cohesive plan for the patient’s mental and physical health. Their health management has been fragmented, in my opinion this is one of the main obstacles to improvement. Through several levels of care and medical professional management we are able to defragment the patient’s health care and improve their overall outcome here at Pacific Quest and beyond.

This is why Pacific Quest is starting to have a presence at integrated medical conferences such as the AANP. Standing in front of hundreds of my colleagues, presenting this integrative model and showing it in action fills me with pride. As I live this model in my own personal and professional life, I declare with passion that this model works. I am elated to continue building on the care for our Pacific Quest patients while reaching out to as many families as we can to improve their understanding of their child’s overall health issues.

February 15, 2012

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Pacific Quest’s Five Pillars of Health

By Britta Zimmer, Medical Director

Every week at Pacific Quest wilderness therapy program we discuss and engage in the five pillars of health. This week we discussed the pillars of health and how they contribute to strengthening the immune system.

The pillars of health are:

Pacificquest wilderness therapy program1. Diet/ Nutrition

2. Mind/ Body Connection

3. Sleep

4. Breathing

5. Exercise/ Movement

At Pacific Quest all five of these pillars are reinforced daily leading to healthier and happier students.

What can weaken the body’s immune system?

Stress, sugar, poor sleep quantity and quality, eating processed food and junk food, not exercising, suppressing your emotions, smoking, alcohol, and recreational drugs

What can you do on a daily basis to keep your immune system strong and healthy?

Move: move your body daily, work in the garden, exercise, take a walk, stretch, take the stairs.
Eat well: eat whole foods and plenty of fruits and vegetables, stay on the periphery of your supermarket, the middle contains processed foods and the periphery contains the fresh produce, dairy and meats.
Sleep well: sleep at least 7 hours per night and do not use substances to induce sleep as they can disrupt your sleep architecture, meaning quality of sleep.
Breathe: take deep breaths to calm your nervous system and detoxify, breathe fresh air, use a HEPA air purifier in your bedroom if you live in a city.
Water: drink a lot of filtered water, drink half your body weight in ounces daily, for each alcoholic or caffeinated beverage consumed add another 8 ounces of water.
Calm the mind to moderate stress: talk about your emotions, reserve at least 10 minutes of quiet time daily to clear the mind and breathe, some people call this meditation.