Archive for the ‘PANS’ Category

Pandas & Lyme in a 7-Year Old

https://danielcameronmd.com/pandas-and-lyme-disease-in-a-7-year-old-child/

PANDAS AND LYME DISEASE IN A 7-YEAR-OLD CHILD

PANDAS-Lyme-disease

Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this podcast, I will be discussing the case of a 7-year-old child who was initially diagnosed with PANDAS and later, Lyme disease.

The article by Cross et al. entitled “Case Report: PANDAS and Persistent Lyme disease with Neuropsychiatric Symptoms: Treatment, Resolution and Recovery” was published in Frontiers in Psychiatry. [1]

The 7-year-old girl developed multiple physical and neuropsychiatric symptoms six months after travelling to a tick endemic region of the U.S. During this period, she was treated for 3 separate strep infections and was subsequently diagnosed with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS). PANDAS was considered based on classic symptoms and a history of strep, a positive ASO titer and a slightly elevated DNase B titer.

However, despite treatment, the patient’s symptoms continued to worsen. Additional testing revealed that she was also positive by CDC’s criteria for Lyme disease. The Lyme EIA and western blot IgM were positive (with 2 of 3 bands). The western blot IgG was positive for 3 of 10 bands at the IGeneX lab. Her B. henselae IgG was positive at Quest labs. Her IgG Mycoplasma and IgG Babesia duncani antibodies were positive at IGeneX.

Dr. Charles Ray Jones, co-author and treating physician, describes the patient’s broad range of symptoms.

Neuropsychiatric symptoms

On her first visit, “the patient presented with crying, anxiety, headache, joint pain, decreased cognitive functioning, fatigue, nighttime awakening and an extreme fear of sleeping alone.”

The patient’s symptoms were extensive, Jones explains, and included:

• Obsessions, compulsions
• ADHD-like behavior
• Decline in school work
• Separation anxiety
• Panic attacks
• Muscle and joint pain
• Mood lability
• Aggressive behavior
• Fatigue
• Headaches
• Difficulty sleeping
• Word selection problems
• Cognitive decline
• Irrational fears (would not sleep alone)

Functional decline 

The young girl was considered a gifted child and excelled in academics. But cognitive symptoms emerged. She reportedly told her mother, “Mom, something happened to my brain.”

“The patient regressed from being a year ahead of her class in math, to being unable to add beyond the number 10. She began having trouble comprehending more difficult reading,” the authors explain.

“During a ride home with her mother, the patient asked, ‘Who are you? What’s your name again?’ And ‘I know you are mommy but what’s your name?’”

Lyme disease, PANDAS and PANS

PANDAS may be diagnosed when a strep infection triggers multiple neurologic and psychiatric symptoms. PANS or Pediatric Acute-Onset Neuropsychiatric Syndrome, on the other hand, may be triggered by other bacterial, viral or fungal infections. Researchers believe that Borrelia burgdorferi, the bacteria that causes Lyme disease can trigger PANS in some patients.

Lyme disease, PANS and PANDAS can present with similar symptoms. Dr. Bransfield, a psychiatrist who specializes in tick-borne diseases, describes a broad range of neuropsychiatric symptoms that he has seen in his Lyme disease patients. [2]

These include: behaviors associated with developmental disorders or autism spectrum disorder, schizoaffective disorders, bipolar disorder, depression, anxiety disorders (panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, intrusive symptoms), eating disorder, decreased libido, sleep disorder, addiction, opioid addiction, cognitive impairments, dementia, seizure disorders, suicide, violence, anhedonia, depersonalization, dissociative episodes, derealization and other impairments.”

Treatment

According to the authors, the child was treated with multiple courses of oral and IV antibiotics including: intravenous ceftriaxone, Omnicef 300 mg BID, Zithromax 250 mg BID, 500 mg BID and Tindamax 250 mg QD (Saturdays and Sundays only), Bactrim and Mepron. Despite this, her symptoms continued and the Cunningham Panel™ of tests was ordered.

Cunningham Panel™ and IVIG

“The Cunningham Panel was ordered to assess the presence of antineuronal antibodies against specific neuronal receptors,” the authors write. “If the Cunningham Panel is positive or strongly positive, that would be an indication that one has an autoimmune problem that needs to be treated with IVIG, as well as antibiotics,” explains Jones.

READ MORE: Highlights from the case report

Panel results indicated the patient had elevated levels for 3 out of 4 autoantibodies: Dopamine D1 Receptor (DRD1), Dopamine D2L Receptor (DRD2L), and Tubulin (TUB).

“Based upon the patient’s Cunningham Panel tests results, the decision was made to prescribe IVIG,” the authors write.

“Over a span of 31 consecutive months of treatment with various antimicrobials and 3 courses of IVIG she experienced complete remission and remains symptom free at the time of this publication.”

Outcome

“Currently this patient appears to be fully recovered and has been discharged from the care of the pediatric Lyme disease specialist. She is asymptomatic and performing academically at the “top” of her class according to her mother,” the authors write.

According to Jones, “multiple concomitant infections may be involved and require treatment to effectively resolve symptoms. Improvement in neuropsychiatric symptoms does not typically occur unless all co-infections are addressed and resolved.”

This podcast addresses the following questions:

  1. What is Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS)?
  2. What are the typical symptoms of PANDAS?
  3. What are the similarities between Lyme disease, PANS and PANDAS?
  4. Why was Lyme disease and other tick-borne illnesses considered?
  5. Why was the name Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) introduced?
  6. What is the Cunningham Panel™ of tests and why was it ordered?
  7. What tests did the girl have that supported the diagnosis of a tick-borne illness?
  8. Can you discuss the range of symptoms this patient experienced?
  9. Can you discuss the girl’s treatment for PANS?
  10. Can you discuss the girl’s treatment for Lyme disease, Bartonella, and Babesia duncani?
    Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website @DanielCameronMD.com. As always, it is your likes, comments, reviews, and shares that help spread the word about Lyme disease. Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.

References:
  1. Case Report: PANDAS and Persistent Lyme Disease With Neuropsychiatric Symptoms: Treatment, Resolution, and Recovery. Cross A., Bouboulis D., Shimasaki C., Jones C.R. Front. Psychiatry, 02 February 2021
  2. Bransfield RC. Suicide and Lyme and associated diseases. Neuropsychiatr Dis Treat. 2017;13:1575-1587. Published 2017 Jun 16. doi:10.2147/NDT.S136137.

___________________

For more:  

Mom Dealing With PANS & Lyme: “2020 is NOT My Worst Year”

https://www.lymedisease.org/from-a-mom-dealing-with-pans-and-lyme-2020-is-not-my-worst-year/

From a mom dealing with PANS and Lyme: “2020 is NOT my worst year”

What is PANS/PANDAS? And Why Are Cases On The Rise?

https://www.linkedin.com/pulse/what-panspandas-why-cases-rise-jill-c-carnahan-md/

What Is PANS/PANDAS? And Why Are Cases on the Rise?

Jill C. Carnahan, MD
Founder, Medical Director, Flatiron Functional Medicine

Imagine a loving child who’s been hitting all of their developmentary milestones. Then, seemingly overnight, she becomes so aggressive and full of rage that she’s kicked out of her preschool.

Or, a high-achieving, straight-A middle school student that suddenly begins having difficulty concentrating or even remembering what he learned the day before.

Or, how about a bubbly and social teenager that has a complete personality change and can no longer leave the house due to severe anxiety.

Unfortunately, for a growing number of parents, these frightening and heartbreaking scenarios have become their reality. More and more children are being diagnosed with autoinflammatory neurological disorders known as PANS and/or PANDAS. Today, we’re going to dive into exactly what PANS/PANDAS is, why cases are on the rise, and what you can do to minimize your own child’s risk of developing these disorders.

What is PANS?

PANS and PANDAS are both related autoimmune conditions that disrupt children’s neurological function. PANS is an acronym for Pediatric Acute-onset Neuropsychiatric Syndrome. PANS is a broad classification and can be caused by nearly any infection. Some more common infectious agents that have been linked to PANS includes:1

  • Mycoplasma pneumonia
  • Influenza (the flu)
  • Epstein Barr (Mono)
  • Borrelia Burgdorferi (Lyme disease)
  • Varicella (Chickenpox)
  • Herpes simplex
But any infection that triggers an immune response can potentially cause PANS.

What is PANDAS?

PANS also encompasses the more well-known subset of this disorder known as PANDAS. PANDAS is an acronym for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection.2 As the name implies, PANDAS is triggered by a streptococcal (strep) infection.

PAN and PANDAS are grouped together because PANDAS is considered a subset of PANS – with both conditions causing severe neurological symptoms. Let’s take a look at exactly what these oftentimes alarming and scary symptoms can look like.

What Are the Symptoms of PANS/PANDAS?

PANS and PANDAS cause a sudden, and rapid-onset onset of neurological symptoms – meaning symptoms involving the brain, spinal cord, and all nerves throughout the body. PANS and PANDAS affect children, typically anywhere from age three through puberty. Seemingly overnight, children can present with symptoms including:3

  • Obsessive-compulsive thoughts: the inability to put thoughts out of their mind or a strong urge to perform repetitive actions.
  • Tics or purposeless motor movements: this may be uncontrolled repetitive symptoms such as jerky movements, sounds (like grunts), or repeating words over and over.
  • Mood changes and mood swings: this can include irritability and moodiness as well as inappropriate emotional responses such as laughing or crying unexpectedly.
  • ADHD type symptoms: such as difficulty concentrating, fidgeting, inability to sit still, and hyperactivity.
  • Separation anxiety: severe “clinginess” or difficulty being separated from parents or caregivers.
  • Changes in motor skills: often this is seen as a sudden acute difficulty with handwriting and other fine motor skills.
  • Sleep problems: children may have difficulty falling or staying asleep.
  • Increased urination: this can manifest as night-time bedwetting, an increase in urination frequency during the day, or both.

These symptoms are almost always abrupt and dramatic – causing children to change almost overnight and out of the blue. But how exactly does PANS/PANDAS cause these sudden and frightening changes in children?

What Causes PANS/PANDAS?

PANS/PANDAS is directly caused by an infection, either streptococcal or otherwise. Regardless of the infectious agent, the process goes something like this:3,4

  • Step 1: Your child comes into contact with an infectious agent and an infection is contracted. Streptococcal bacteria and other infectious microorganisms have evolved to survive in the human body by evading our immune systems for as long as possible. These microbes essentially “hideout” in your child’s body – putting specific molecules on their cell walls that are nearly identical to the molecules found on your child’s own tissues. This is called “molecular mimicry” and helps these foreign invaders evade detection so they can begin replicating.
  • Step 2: Eventually the immune system is alerted to these foreign invaders and an attack is launched in an attempt to neutralize the threat. But because these foreign microbes closely resemble the host cells, the immune system begins mistakenly attacking the invading microorganisms and the healthy cells that were mimicked.
  • Step 3: In PANS/PANDAS, the immune system begins targeting a part of the brain known as the basal ganglia. The basal ganglia is responsible for motor functions and learning as well as behaviors and emotions.5 So, as the immune system launches its misguided attack on the basal ganglia, inflammation levels skyrocket – causing a rapid and severe onset of neurological symptoms.

So what are the next steps if your child presents with the intense and debilitating symptoms seen in PANS/PANDAS?

Is There Treatment for PANS/PANDAS?

Unfortunately, because PANS/PANDAS manifests as neuropsychiatric issues, cases are often misdiagnosed as behavioral disorders or mental illness – oftentimes resulting in children being placed on psychiatric meds. But when properly diagnosed, treatment of PANS/PANDAS requires addressing the root cause of the symptoms – the underlying infection and subsequent inflammation and autoimmune response.

Typically PANS/PANDAS is treated with anti-infective and/or immunological treatments. Anti-infectives target the underlying infection, and immunological treatments target the immune system. Treatment may resolve symptoms, but in some cases, symptoms may only be diminished – leaving children with ongoing neuropsychiatric issues. This often requires cognitive-behavioral therapies to manage lingering symptoms. 

Undoubtedly, as a parent, the thought of your child potentially contracting PANS/PANDAS and dealing with the life-altering effects of these disorders is extremely concerning. And what’s more concerning, is that cases of PANS/PANDAS are on the rise.

Why Are PAN/PANDAS Cases Are on the Rise?

Exposure to germs and the contraction of infections are inevitable in children. In fact, this activation of the immune system is a crucial part of development and building acquired immunity. But the problem arises when exposure to these infectious agents causes the immune system to go awry.

You see, modern life has a major impact on both children’s and adult’s immune systems. Certain factors can increase the likelihood of a child’s immune system misfiring and causing autoinflammatory conditions such as PANS/PANDAS. Factors that negatively impact the immune system and increase the risk of autoimmunity include:

  • Increased exposure to toxins and inability to properly detox
  • Gut dysbiosis and nutritional deficiencies
  • Increased stress levels and inadequate sleep

Let’s take a deeper look at how addressing these factors and prioritizing immune health can decrease your child’s risk of developing autoinflammatory disorders like PANS/PANDAS.

Ways to Support Your Child’s Immune System

While there are certainly no guarantees when it comes to your child’s health, the most powerful weapon we have against autoinflammatory disorders is keeping the immune system in tip-top shape. Some of the best ways you can keep your child’s immune system firing on all cylinders include:

Reducing Toxic Burden

We’re all exposed to countless potentially harmful toxins on a daily basis. Our bodies are designed to process out these toxins and maintain homeostasis. But when exposure to toxins overwhelms the body’s ability to properly detox and they begin to accumulate, it can spell trouble.

You see, a build-up of toxins activates your child’s immune system, causing low-level inflammation. Over time, this constant activation overworks the immune system. This not only depletes your child’s immune system’s resources – leaving it with less energy to direct at potential threats – but can also increase the chances of their immune system misfiring and the development of autoinflammatory conditions.

While it’s impossible to entirely avoid exposure to toxins, there are some simple steps you can take to make your child’s environment less toxic and reduce their overall toxic burden. Head over to my article How to Boost Your Immune System by Reducing Your Toxic Burden to learn exactly how you can start addressing the toxin levels in your home today.

Focusing on Gut Health

The immune system and the gut are intricately linked. In fact, the gut houses approximately 70% of your immune cells and plays an integral role in coordinating and regulating immune responses. So it’s no surprise that if gut health is out of whack, then the immune system can’t function properly.

There are two primary components to keeping your gut – and subsequently your immune system – happy and healthy:

  1. The integrity of the lining of your gut: Your child’s digestive tract is frequently exposed to foreign pathogens through the food and drinks they ingest. The lining of the gut is designed to keep these potentially dangerous microorganisms sealed up tight so they can be safely eliminated.
  2. The microbiome: Millions of different beneficial microorganisms reside in your child’s gut. This delicate ecosystem plays a crucial role in communicating with the immune system, keeping “bad” bacteria in check, and producing essential metabolic compounds.

Supporting both of these components of gut health is pivotal when it comes to supporting immune function. Some simple ways to help keep your child’s gut healthy and happy include:

  • Build meals around real whole foods. Teach your children to fill up on fresh fruits and veggies, high-quality protein, and healthy fats.
  • Minimize sugary foods and simple carbs. Sugar-laden and processed foods can cause an imbalanced microbiome and increase inflammation.
  • Introduce beneficial bacteria by incorporating fermented foods like sauerkraut, coconut yogurt, kombucha, and kefir. Or try a kid-friendly probiotic – just make sure to consult with your pediatrician first.

To learn more about how a healthy gut equals a stronger immune system, head over to my article How to Heal Your Gut for a Stronger Immune System.

Prioritizing Rest and Relaxation

With schoolwork, standardized tests, sports, and extracurricular activities, kids today have a lot of stress and seem to be constantly on the go. And that stress can put a serious damper on their immune systems.

Teaching your kids to balance activities and achievements with rest, fun, and connecting with others is crucial to their overall health. Help them find ways to channel and process the unavoidable stress with things like journaling or meditation. Keeping stress levels in check is one of the most powerful ways to support your child’s immune function.

So, How Worried Should I Be About PANS/PANDAS?

As a parent, you love your children and the thought of them developing PANS/PANDAS feels like a nightmare that you never want them to go through. That’s why staying informed and supporting your children’s immune systems is crucial.

If you’re concerned that your child may be suffering from the effects of either of these debilitating disorders, I strongly encourage you to seek the expertise of an experienced Integrative and Functional Medicine Practitioner. If you’ve never worked with an Integrative and Functional Medicine Practitioner, click here to learn how to pick the right one for your family.

When it comes to the health of your family and bolstering your child’s defenses against autoinflammatory disorders like PANS/PANDAS, you are your child’s best advocate. Staying educated, creating a healthy lifestyle for your family, and teaching your children to prioritize their own health is a powerful way to minimize the risk of developing autoimmunity.

And I’m here to help you. I’m dedicated to bringing my patients and readers the knowledge and resources they need to stay educated and feel empowered. So if you want access to my exclusive and very best tips when it comes to staying healthy, I encourage you to sign up for my newsletter. All you have to do is enter your name and email in the form below and you’ll get all my best content delivered straight to your inbox!

If you’d like to read more on PAN/PANDAS you may also want to read blog articles like these by my friend, Dr. Suzanne Gazda, Integrative Neurologist.

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340805/
  2. https://www.pandasppn.org/what-are-pans-pandas/
  3. https://www.nimh.nih.gov/health/publications/pandas/index.shtml
  4. https://www.moleculeralabs.com/pans-and-pandas-overview/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543080/

* These statements have not been evaluated by the Food and Drug Administration. The product mentioned in this article are not intended to diagnose, treat, cure, or prevent any disease. The information in this article is not intended to replace any recommendations or relationship with your physician. Please review references sited at end of article for scientific support of any claims made.

_____________________

For more:  https://madisonarealymesupportgroup.com/2017/10/01/panspandas-steroids-autoimmune-disease-lymemsids-the-need-for-medical-collaboration/

https://madisonarealymesupportgroup.com/2017/12/01/guidelines-for-treating-pans-its-real/

https://madisonarealymesupportgroup.com/2020/03/24/is-your-child-crazy-or-sick-mental-illness-vs-medical-disorder/

https://madisonarealymesupportgroup.com/2017/10/08/misdiagnosed-how-children-with-treatable-medical-issues-are-mistakenly-labeled-as-mentally-ill/

https://madisonarealymesupportgroup.com/2019/05/13/one-familys-story-of-strep-lyme-disease-and-pans-pandas/

https://madisonarealymesupportgroup.com/2019/07/08/psychosis-and-pans-meet-plasmapheresis-our-final-slam-dunk/

https://madisonarealymesupportgroup.com/2018/08/01/the-3-pans-myths-that-are-ruining-lives/

https://madisonarealymesupportgroup.com/2018/07/28/stories-of-pandas/

Associations Between COVID-19, PANS/PANDAS, and Biotoxin Illness

The interconnections between COVID-19, PANS/PANDAS, & biotoxin illness

Dr. Jodie Dashore discusses possible associations between COVID-19 and PANS/PANDAS as well as biotoxin illness, from what we know so far, and ways to strengthen oneself in the face of all these conditions. Dr. Dashore has a wide spectrum of plant-based therapy options for chronic disease, and particularly sees patients with autism, PANS/PANDAS, mould illness and Lyme Disease. She also answered questions live during the webinar.

For more:  https://madisonarealymesupportgroup.com/2019/01/27/pans-pandas-autoimmune-encephalitis-rickert-hong/

https://madisonarealymesupportgroup.com/2017/12/01/guidelines-for-treating-pans-its-real/

https://madisonarealymesupportgroup.com/2018/12/17/my-kid-is-not-crazy-study-shows-1-3-kids-with-pans-have-hallucinations/

https://madisonarealymesupportgroup.com/2017/06/30/child-with-lymemsidspans-told-by-doctors-she-made-it-all-up/

https://madisonarealymesupportgroup.com/2018/07/28/stories-of-pandas/

https://madisonarealymesupportgroup.com/2018/01/05/scary-side-of-childhood-strep/

https://madisonarealymesupportgroup.com/2018/11/06/diagnosing-treating-autoimmune-encephalitis-in-patients-with-persistent-lyme-symptoms/

https://madisonarealymesupportgroup.com/2017/10/01/panspandas-steroids-autoimmune-disease-lymemsids-the-need-for-medical-collaboration/  Boy’s Lyme Disease Morphs into Autoimmune encephalopathy.  It took 10 years and 20 doctors to find out 12-year-old Patrik had Lyme disease. Just 4 months later the doctors discovered he also has a condition where his immune system attacks his brain.

Study Links Eating Disorders to Childhood Infections (Lyme/MSIDS Can Do This)

https://giving.massgeneral.org/eating-disorders/

New data from a Mass General researcher highlights a link between the immune system and the onset of eating disorders.

The question of what causes eating disorders has puzzled the medical community since “wasting disease” was first described in the 17th century. Today, researchers and clinicians agree that, in addition to psychosocial and environmental risk factors, there is a strong biological basis to these disorders. Now, new data from a Massachusetts General Hospital researcher suggests that exposure to common childhood infections, such as strep throat or bronchitis, may significantly raise a person’s risk of developing anorexia nervosa, bulimia nervosa and other eating disorders.

“Infections, by and large, have typical behaviors associated with them, and among those most commonly reported is loss of appetite.”

Results of the population-based study, published in JAMA Psychiatry, found that infections that required hospitalization or treatment with anti-infective medications, such as antibiotics, antifungals or antivirals, increased the risk of developing an eating disorder by as much as 39%. The multi-institutional study, which analyzed the health histories of more than 500,000 adolescent girls in Denmark, also found that recurrent infections and repeated treatment increased the risk.

Infections and Behavior

“Infections and inflammation more broadly have been recognized to play a role in psychiatric diseases like schizophrenia, but this has been less explored in eating disorders,” says Lauren Breithaupt, PhD, a clinical psychologist in the Mass General Eating Disorder Clinical and Research Program, and lead author of the study. “We’re hoping that a better understanding of the relationship between the immune system and disordered eating will help identify a mechanism behind the increased risk and biochemical changes we see happening.”

Lauren Breithaupt, PhD
Lauren Breithaupt, PhD

As an observational study, the findings don’t point to a single cause or effect, but one possible explanation, according to Dr. Breithaupt, is that the infection or treatment of the infection disrupts the gut microbiome, which in turn alters the brain’s neurobiological reward system. Another possibility is the body’s own inflammatory response. Inflammatory proteins have been shown to cause changes in behavior, such as loss of appetite.

“Infections, by and large, have typical behaviors associated with them, and among those most commonly reported is loss of appetite,” Dr. Breithaupt says. “If you’re already at risk for an eating disorder, this period of no appetite could have a priming effect.” Although more research is needed, Dr. Breithaupt is encouraged the findings further enforce the biological nature of the disease.

Eating Disorder Stereotype

Eating disorders have long been seen as social constructs — think of the stereotype of the wealthy white girl who isn’t eating because she wants to look a certain way,” says Dr. Breithaupt. “It’s taken a lot of evidence — more than most other mental illnesses — to blow that stereotype out of the water. We now know that the rates are similar across the world and across cultures. We’re even seeing that there may not be as big a gender discrepancy as we previously thought.”

Despite mounting biological evidence, there is still a great deal of confusion in the medical community about how to diagnose and treat eating disorders. Dr. Breithaupt is hopeful that the team’s findings can lead to increased awareness of the signs and symptoms and that more hospitals and treatment centers adopt a more scientific approach to treating these diseases.

The Role of Philanthropy

“The Eating Disorders Clinical and Research Program at Mass General offers gold standard evidence-based treatment for eating disorders, but we receive so many referrals per year that unfortunately we can’t treat every patient who seeks services,” she says. “That’s why philanthropy is so important to the growth of our program. The work that we do is often funded by individuals and families who have been touched by these diseases.”

The other key to advancing the understanding and treatment of eating disorders, Dr. Breithaupt says, is education.

“In order to identify biological markers, we need larger sample sizes and data sets, which requires individuals with the disorder to come forward and to participate in research,” she says. “By educating the public about the biology underlying eating disorders, we can break down barriers and overcome the stigma.

To learn more about how you can support eating disorder programs and research at Mass General, please contact us.

________________

**Comment**

Great read and a fantastic reminder that eating disorders often have a biological basis.

If a wild animal is sick with an infection it stops eating. This begins to make sense when we understand that nearly 5-15% of our body’s energy goes into digestion:  http://discovermagazine.com/2009/dec/20-things-you-didnt-know-about-digestion

According to Dr. Bransfield eating disorders are common with Lyme/MSIDS:  https://madisonarealymesupportgroup.com/2015/10/18/psychiatric-lymemsids/

In addition, Lyme can trigger a condition known as pediatric acute-onset neuropsychiatric syndrome (PANS) which in turn can also cause eating disorders. http://www.childrenslymenetwork.org/children-pans-pandas/  PANS, similarly to Lyme, still has not been accepted by mainstream medicine despite thousands upon thousands suffering from both.

For more on PANS:  https://madisonarealymesupportgroup.com/2017/12/01/guidelines-for-treating-pans-its-real/ In short, treat the infection(s), inflammation, and deal with the psychiatric issues.

Hypoglycemia can also be a player. And according to this article, insulin resistance “causes the body to have problems metabolizing carbohydrates into biological energy called ATP. This energy is essential in the production of feel good neurotransmitters such as serotonin. Thus without that energy the person may tend to feel depressed. The unabsorbed carbohydrates are converted to, first, glycogen and then into fat cells. Thus we find that depressed people may be overweight AND depressed. They are not depressed because of obesity, but because of insulin resistance!! (MedicalNewsToday 8 Oct 2009) See also Hemat.”  http://www.hypoglycemia.asn.au/2011/eating-disorders-anorexia-and-bulimia/

The article has great advice if you suspect hypoglycemia is your issue:

“If you suspect that an eating disorder is related to insulin resistance (a pre-diabetic condition called hypoglycemia) then have this tested by a doctor. See How to test for hypoglycemia. If found to be positive, encourage your client to adopt the Hypoglycemic Diet.

For most people sticking to a regime of frequent snacks of high proteins (every 2 ½ hours), plus various vitamins and mineral – so as never to feel hungry – should supply sufficient energy from proteins to produce feel good neurotransmitters such as serotonin. This together with regular – but not excessive –  exercises should prevent unabsorbed carbohydrates from being converted to fat cells! But keep in mind possible allergies and food sensitivities that may affect the digestive system.”

I knew a patient who was not over weight at all but due to severe hypoglycemia and hypothyroidism they developed eating disorders. When they adopted the hypoglycemic diet and began supplementing with natural thyroid hormone the eating disorders disappeared.
Please spread the word as many doctors will only continue to look at this as a psychiatric problem when there are often biological causes.