Wholeness Holistic Health Blog

by Dr. Scott Shannon

The last twenty years has witnessed the emergence of Integrative Medicine, a new specialty in health care. Originally called Complementary and Alternative Medicine (CAM), this field exploded with the 1993 NEJM article by David Eisenberg, MD of Harvard that documented the level of interest and utilization of CAM in the US.  For example, most people were shocked to discover that Americans had more visits (in 1991) to CAM providers than to primary care physicians with that number growing in disparity each year.

In 1994 Andrew Weil, MD initiated a post-graduate fellowship program in CAM at the University of Arizona and called it Integrative Medicine (IM). The philosophy centers on the integration of safe and effective treatment modalities from all traditions. Typically, it includes a focus on evidenced based treatments from areas such as nutrition, lifestyle change, mind-body medicine, herbal medicine and traditional practices (such as acupuncture). The goal is to bring the scrutiny of western medicine to the exploration and integration of other practices that may have much to offer. The push for IM is being driven by rising consumer demand and interest.

Now, 46 medical schools have academic programs in Integrative Medicine with the number growing every year. These universities, including University of Colorado, have formed an organization called CAHCIM (Consortium of Academic Health Centers in Integrative Medicine). CACHIM sponsored an International Conference on IM Research that drew over 700 physicians from around the globe last year. Lisa Corbin, MD, an internist, leads our clinical program at CU. Children’s Hospital in Denver has also begun development of an Integrative Pediatrics program under the leadership of Rachel Workman, MD.

As the number of physicians working in this arena explodes, the field is making efforts to validate and certify training. The American Board of Integrative Holistic Medicine (ABIHM) was founded in 1996 in an effort to develop validation and bring educational consistency to this field. Currently, over 1300 MDs and DOs have been board certified. The ABIHM (www.holisticboard.org) offers a five-day board review course that is provides an excellent overview of this field. The grandfathering period for licensed physicians appears to drawing to a close for those who have not completed a formal training program in IM. As more and more IM training programs come on line the field moves in the direction of formal ABMS recognition.

Integrative Psychiatry (IP) functions as a subset of IM and is relatively new on the scene. The APA has had a caucus on IP for about 4 years lead by James Lake, MD, author of two textbooks in this new arena. The AACAP recently (2/10) announced the formation of a new committee on Integrative and Complementary Psychiatry and we will have our first formal meeting in New York in October. The University of Arizona hosted the first annual conference on Integrative Mental Health in Phoenix this past March. Daniel Siegel, MD and I represented Child Psychiatry on the program. As a sign of the intense interest in this new field, the conference sold out two months prior with over 700 professionals registered. Plans are underway for the second installment of this conference next year.

Closer to home, the child and adolescent psychiatry residency at CU/Children’s has been a national leader in integrative programming for years under the supportive leadership of Marianne Wamboldt, MD. Yoga classes there have been very successful for children with somatic and chronic pain issues. In that setting I have offered an elective in Integrative Child Psychiatry for four years. This year long elective highlights the application of evidenced based nutritional and herbal interventions in an outpatient setting. Three of the four residents that completed this elective have entered private practice with an integrative approach to patients. In Fort Collins, Mike Mullin, MD and I are expanding our practice and will open a large interdisciplinary Integrative Child Psychiatry clinic this fall called Wholeness Center.

As you can see this is a rapidly expanding field, still in its infancy that is driven by huge patient demand. The educational opportunities are manifold, given the fact that most psychiatrists encountered little formal training on these topics. Concomitantly, the research base is also exploding with an escalating number of studies being released each year. If you would like to learn more, following this article is a brief list of some useful resources.

Kaplan, Bonnie and Shannon, Scott   “Nutritional Aspects of Child and Adolescent Psychopharmacology” in Psychiatric Annals, 37:7, 519-528, 2007
Kemper, K and Shannon, Scott   “Complementary and Alternative Therapies in Pediatric Mood Disorders” in Pediatric Clinics of NA, 54, 901-926, 2007
Lake, James    Textbook of Integrative Mental Health   Thieme,  2008
Lake, James and Spiegel, David    Complementary and Alternative Treatments in Mental Health  APPI,  2007
Newmark, Sanford    ADHD Without Drugs  Brigham, 2010
Shannon, Scott   Handbook of Complementary and Alternative Therapies in Mental Health,  Academic Press, 2002

by Dr. Scott Shannon

The American medical profession has rejected and avoided the science of nutrition for over a century. This curious and unfortunate prejudice goes back in history to the mid-1800’s when allopathic physicians (MDs) were fighting for financial survival with homeopaths and eclectic physicians (forerunners of naturopaths). Both of these groups emphasized diet and naturals cures. The American Medical Association was formed to help the MDs fight off this threat. The AMA issued an edit that made it grounds for sanction if you worked with one of these heretical groups. The bias continues to this day.

Most American physicians ignore well-proven nutritional interventions in spite of solid science, low cost, good safety and exploding patient demand. Our doctors dismiss the value of nutrition without understanding or exploring the information. The pattern is set in medical school where minimal time is devoted to this topic. Sadly, nowhere is this anti-nutrition mindset more obvious than in the specialty of psychiatry.

The brain forms the obvious foundation for the importance of nutrition in mental health or illness. The process of brain growth transforms a few embryonic cells into the most complex system in the known universe. At one point in the first trimester over 250,000 neurons are being created per minute. This extraordinary process does not stop at birth: the human brain quadruples in weight after delivery. The child’s brain is much more complex than our adult brain with twice the number of neurons and much more rapid synaptic growth and interconnection.

This enormous neurological development has vast metabolic and nutritional demands. If the child’s diet does not supply the needed nutrients (omega-3 essential fatty acids, magnesium, b-vitamins, amino acids, folate, etc) than the child’s brain will be handicapped and prone to dysfunction and psychiatric symptoms.

Sadly, the American diet continues to deteriorate. Over two thirds of our kids fail to meet the dietary recommendations for one or more nutrient. Only 1% of Americans eat according the food pyramid guidelines. Fully 65% of our calories now come from sugar and fat. Our intake of magnesium has fallen dramatically in the last century. Also because of feedlots, fast foods and hydrogenated oils our ratio of omega-3 oils to omega-6 oils has deteriorated from 1:1 to 1:20 in the last 150 years. Most Americans are deficient is this key neurological building block. American breast milk has the lowest levels of DHA (an omega-3 EFA) in the developed world. Our children must have DHA and other omega-3 nutrients to build a functioning brain. A starving brain is a symptomatic brain.

We have witnessed an explosion of child psychiatric illness in the last 30 years. For example, a 2007 study found that the rate of diagnosis of pediatric bipolar disorder (one of the most severe and difficult to treat problems in childhood) increased by 40 FOLD in the last 10 years. Adult illness in the same study did not even double. I believe one reason for this epidemic is nutritional deficiency. There are obviously many different problems created by a wide variety of nutritional issues. Each child is different. Only recently with advanced genetic science have we come to realize how different and unique we are in our individual biochemistry. Scientist have long known that the need for vitamins and nutrients vary widely from person to person. The requirement for a single nutrient can range from 10 to 1 or even 100 to 1 from person to person.

Recently, the number of nutritional compounds found to be effective or helpful in psychiatric disorders has dramatically risen. Folate, B-6 and SAMe have proven value in treating major depression. Chromium has good evidence for improving atypical depression. A number of studies document the value of magnesium in mood disorders and its shows great similarity to the mineral lithium in its effects upon neurons. A 2006 study found that 7/10 children with major depression got better with omega-3 oils versus 0/10 with a placebo. Suddenly, we have scientific proof that nutrition helps to heal psychiatric disorders.

Psychiatric medications are the preferred tools in child psychiatry. Unfortunately, the evidence that this approach is safe or effective is clearly inadequate. Most parents have real caution about medicating their child’s growing brain. The vast majority of parents that I speak to across the US are ecstatic about safe and natural approaches for childhood mental health issues like attention, depression, anxiety and aggression.

My approach provides a foundation of healthy diet, lifestyle adjustments and proven supplements before we consider medications. I am not anti-medication; rather I believe that we must offer safer and more natural options for adjusting biochemistry before considering powerful pharmaceuticals. Beyond that, doesn’t it make more sense to correct biochemistry before we medicate the developing brain? Common sense tells me that the nutritional approach to psychiatric signs and symptoms in children makes the most sense as a first step.

As I mentioned, in recent years we have witnessed an explosion of children and teens labeled with bipolar disorder. These kids are aggressive, violent and out of control. Our current medications are not very effective. A growing number of psychiatrists around the country have been using a vitamin/mineral product to effectively treat this disorder. A well-known Harvard child psychiatrist, Charles Popper, MD in 2001, popularized this approach. He published a report in a psychiatric journal about his experience: he treated a 10 year old boy with severe bipolar with this natural product and the boy was completely symptom free within 5 days. Eleven other published studies on this product have followed (www.truehope.com).

This raises a profound question: If vitamins and minerals can completely eliminate the signs and symptoms of bipolar disorder in children, are these symptoms of an true illness or of a nutritional deficiency syndrome such as scurvy or pellagra?

It is my strong belief and my experience in thirty years of holistic care that diet, vitamins and minerals can clear much of what we call psychiatric illness. A wide range of resources exist for parents and other concerned adults. The first and most crucial step involves the improvement of the diet: reduce processed foods, reduce sugar, reduce additives, and increase fruits and vegetables. I typically find a high protein breakfast works wonders, especially for concentration and school performance issues. Soda has no role in any child’s diet, nor does caffeine. If you do these things your need for psychiatric care will be reduced. If this is not enough find a health care professional (NB-all ABIHM diplomates have had training in this arena and will usually work with vitamins, minerals and supplements). Additionally, I have a number of relevant articles on my website: www.wholenessdoc.com. The proper diet represents the best first step for mental health issues in children. It is safe, effective and just plain makes good sense.

With the dramatic increase in adults and children being diagnosed with chronic illnesses, the hope for a healthy future can be lost. Fort Collins is generally a very healthy area of Northern Colorado, but the national statistics are staggering. Nearly twenty percent of U.S. adults experience an anxiety disorder, and one in six children struggle with a developmental disorder. Overall the rate of chronic illness including asthma, obesity and learning problems in children has doubled in the last fifteen years. From anxiety and depression to general family and pediatric health care we aim to restore hope, regardless of diagnosis and without the use of ‘labels’.

In our collaboration with you, we emphasize skill-building, healthful nutrition and lifestyle adjustments as well as strong focus on the power of relationships. We believe that every person has an innate drive for balance and harmony. Our team of holistic doctors will guide you and your family to that place of true wholeness. We are located in Fort Collins, Colorado, serving the entire Northern Colorado community and beyond.