Is it Addiction or Starvation?

1. Talk Therapy or “Just say no” can’t help a genetic difference.

Talk therapy is also beneficial but can not “cure” a biological difference in metabolism.
  • Looking up the definition of the word “disease” suggests that a genetic difference affecting a body wide receptor system might fit the term “body disease.” “Disease: a disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.” – Oxford Dictionaries (I.1.disease)
Redefining the neurobiological underpinnings and genetic risks of the behavior we call addiction could lead to more targeted help for the sufferers of addiction rather than continuing to treat them primarily by focusing on a discussion of their difficulties with motivation or impulse control.
The Endogenous Cannabinoid System holds answers.
Background information:
  • Endogenous refers to something that can be made internally by our body rather than a chemical that is needed to be obtained from an external source on a daily or semi-regular basis. An example such as oxygen from the air we breathe is needed within every few minutes or cellular damage can start to occur; or trace nutrients such as essential fats or fat soluble vitamins may not be needed as often because they can be stored in the fat and membranes of the body. They may only need to be consumed in the diet every few days or weeks without resulting in negative health effects. The body can store extra vitamin D during summer months that can last most of the winter but does start to run out by springtime.
A person with a metabolic difference due to genetics, chronic illness, or the standard changes associated with aging may need an external source of nutrients that other people of average health would be able to make internally – “endogenously.”
  • Cannabinoids are a type of chemical called phospholipids which are formed from a lipid, a type of fat, and the mineral phosphorus.
I have a genetic difference in my ability to phosphorylate (I.2.wikigenes.BHMT) so that I am unable to make phospholiids endogenously and I have found that having an external source of cannabinoids in my diet every day helps my chronic illness conditions and improves my muscle and nerve control. I am registered as a Medical Marijuana patient in a state where it has been legalized for medical use.
     Some of my symptoms that are relieved by the herbal medicine have been troubling me since I was an infant. I had severe eczema throughout my childhood and severe congestion. Rarely could I breathe through both nostrils and nosebleeds were also common. The enzyme the BHMT gene produces when functioning incorrectly is associated with a risk for vascular problems – ie nosebleeds or easy bruising or spider veins or all of them.
     The protein that the gene normally produces is necessary in Glycerophospholipid biosynthesis, metabolism , and Phospholipid metabolism, (so a double mutation in this gene may make it difficult for me to make phospholipids endogenously), among 17 pathways in all – that is an important enzyme: (I.6.genecards.BHMT) And the CDK-mediated phosphorylation and removal of Cdc6 SuperPath involves 97 other pathways which include a Calcium2+ pathway and a Parkinsons Disease pathway and creatine metabolism (important for muscles) and synthesis of DNA and many other metabolic paths/chains of chemical events : (I.7.genecards.phosphorylation)
  • Phospholipids are found in human breast milk and helps stimulate the infant’s appetite and helps support adequate weight gain. The cannabinoids and phospholipid group perform two main functions – they are flexible and form a significant part of membrane walls, like building blocks or bricks; they can also be released from the membrane and act as messenger chemicals that can activate other systems or be modified slightly to become a different type of messenger chemical called eicosanoids.
  • Eicosanoids include the leukotrienes: Santa Cruz Biotechnology,(I.8.scbt.com)

2. It might be motivating to learn of an underlying cause to cravings.

It might help a person to learn that for a person with a genetic difference, difficulties with motivation or impulse control are likely due to an underlying deficiency of a substance they are missing, which would likely have helped them have better impulse control and to not have cravings for substances.
Someone without the genetic difference would be making the substances internally which would help them have good impulse control and not crave substances.
     Helping the person with substance abuse problems to find approved external sources of the substance (cannabinoids) seems like it would be more helpful and potentially more motivating for them to be able to view themselves as a worthwhile person with special dietary needs rather than as an unmotivated drug addict who just doesn’t try hard enough to change.
     Substance abusers likely quit using and relapsed again more times than anyone cares to count. every single time a chronic user runs out of their substance of choice they are “quitting” until they get more.
     Do you blame a hungry person for eating breakfast in the morning? Should a person just “quit eating” if they have an overeating disorder? Answer: No.
  • Cannabinoids might help some types of eating disorders and some types of drug or alcohol addictions by providing an essential nutrient that the person might not be able to make.
  • If the body can’t make an important substance or convert substances into active forms then it becomes an essential nutrient – essential for that specific person’s daily diet.

3. Genetics of the cannabinoid system and binge eating disorder, alcohol abuse and drug addiction.

“It is important to note that, as with alcohol, marijuana, and heroin, a human genetic variant of the cannabinoid CB1 receptor gene CNR1 has been associated with susceptibility to cocaine and amphetamine dependence (Ballon et al. 2006, Comings et al. 1997; Zhang et al. 2004).
  • Behavioral Neurobiology of the Endocannabinoid System; Ch.13: Drug Addiction, (page 334, I.9.Searchworks)
Endocannabinoids: The Brain and Body’s Marijuana and Beyond is a reference textbook available online as a pdf. (I.10.Endo.pdf)  It includes information regarding the genetic differences known to be associated with binge eating disorder and other drug addictions affected by rimonabant, a chemical which inhibits the endogenous cannabinoid system. Use of rimonabant affected craving for food/sucrose and alcohol in animal research, and it was found to reduce rewarding effects of morphine/opioids, amphetamine, cocaine and diazepam in other studies.
  • Rimonabant is not in use for drug addictions because it is associated with a significantly increased risk for suicide. This is an important point to note – blocking the endogenous cannabinoid system is associated with a significant risk for suicide.
The problem with addiction to some substances or to eating excess food for some cases of over eating disorders is an underlying inability to make the cannabinoids but a remaining need for them and a hunger, an urge for “something,” something that is unknown however. And what people choose to consume in order to try to quench that unknown hunger varies from food and alcohol, to the rest of the drugs that are commonly abused.
     Dietary sources are needed instead. However our food supply has limited sources. Vine ripened produce or lemon oil, rich in aroma, are examples of a food containing cannabinoids or a similar group of aromatic and medicinal phytochemicals called terpenes. Chocolate and the herb rosemary are two other food sources. The spices cardamom, cloves, and nutmeg are also sources. Non-euphoric cannabinoids also exist and may have medicinal benefits depending on the patient’s condition. Copaiba oil is a food grade essential oil that can have non-euphoric cannabinoid content with medicinal benefits.
     Wouldn’t it be nicer to tell starving people that they are starving rather than that they are poorly motivated?
  • For more information regarding binge eating disorder, drug addiction and rimonabant: See Ch.3: Endocannabinoid Receptor Genetics and Marijuana Use, (p72-73 & 91, I.10.Endo.pdf) and Ch.13: Behavioral Effects of Endocannabinoids, mentions that research with rimonabant has helped show excessive alcohol drinking behavior and development of alcoholism may be related to genetic differences in the CB1 receptors. (p319, I.10.Endo.pdf)
  • Impulse control deficits may involve the cannabinoid system: See Ch.13: Behavioral Effects of Endocannabinoids, (pp325-330, I.10.Endocannabinoids.Full Text.pdf).
  • Schizophrenia may be related to a deficiency in the cannabinoid receptors themselves rather than being due to a deficiency in cannabinoids: See Ch.15, Neuropsychiatry: Schizophrenia, Depression, and Anxiety,; of the book Endocannabinoids: The Brain and Body’s Marijuana and Beyond: (p378, I.10.Endocannabinoids.Full Text.pdf)
More recently a gene has been identified in binge eating disorder, the gene for the cytoplasmic FMR1-interacting protein 2 (CYFIP2). (I.11.sciencedaily) The gene has a number of known variations and has allso been associated with Fragile X, an autism like condition, ADHD, autism, obsessive-compulsive behavior, and Prader-Willi Syndrome.. (I.12.ncbi.FragileX)
     The enzyme the gene CYFIP2 produces when functioning normally is involved in many metabolic pathways in the body including one that plays a role in myelination of nerve cells and one in phospholipid metabolism. (I.13.reuters) (I.14.genecards.CYFIP2)
     So an external source of cannabinoids might help a person with a problem in their CYFIP2 gene to have normal appetite control and also to protect their nerves from multiple sclerosis – which causes degeneration of myelin.  Myelin is similar to the lipid part of some of the phospholipids of the endogenous cannabinoid system. Multiple sclerosis has been associated with social anxiety and eating disorders (I.15.omicsgroup) which are also conditions associated with gene differences in the cannabinoid system. Myelin is made with sphingomyelin which is made of sphingolipids. (I.16.sphingolipids) Easy right? (I.17.mpcfaculty.lipids) Even easier – coconut oil is about 50% phospholipids and is a good source of sphingolipids. (I.18.coconut)
     I don’t know if I have any differences in my CYFIP2 gene; it was not one of the 30 genes that were included in the Nutrigenomic Screening I had done for my personal use for the “purposes of research.” Genetic screening is only used for certain conditions in standard health care currently and some types of health care claims can not be made by practitioners about genetic screening for other conditions – no guarantees in life or lab tests. The screening I had was designed to test genes commonly found to have differences associated with autism. (I.33.Nutrigenomic Screening) (p22, I.34.example of the genetic screening I had)
     I have a genetic difference in my ability to phosphorylate (I.2.wikigenes.BHMT) The gene I have a double malfunction in, BHMT, is also associated with multiple sclerosis except it seems to be with an over activity rather than too little function. Methionine and homocysteine metabolism and vitamin B12 may be involved. (I.19.BMHT.MS) Hypothyroidism may be associated with over expression of this gene: (I.20.wikigenes)
     The enzyme BHMT/1 (Call – T), Betaine-homocysteine methyltransferase (BHMT), in normal health helps produce the amino acids methionine and Dimethylglycine (DMG).
     DMG has been found helpful in ADHD, autism, allergies, alcoholism drug addiction, and chronic fatigue syndrome among other chronic issues. Methionine has been found helpful in treating depression, allergies, alcoholism and schizophrenia among other chronic issues. Since learning of the difference in my genetics I have been taking the two amino acids in a powder form that I add to a glass of water. It doesn’t taste good but it leaves me feeling more energetic and with a more positive mood.
     What it tasted most like was a tart red wine and the nutrient content of red wine does contain free amino acids, so someone with a problem with the BHMT gene may have problems with unidentified cravings that wine seem to help. While I did love red wine, it didn’t love me. It was one of the first triggers for severe migraines that I identified and started avoiding. A painkiller did help with migraine pain somewhat but zero time spent with a migraine is my goal.
     I found based on the information that is available regarding dose, that a half teaspoon of each of the amino acid powders helped my mood without causing such an energy boost that it caused an increased heart rate or prevented me from going to sleep. I tried one teaspoon of each initially and found that it was too much of an energy boost. Both amino acids can act as activating chemicals within the brain.
     I have early symptoms of neuropathy, I would rather prevent multiple sclerosis than to learn more about it first hand. Taking the supplemental methionine may be helping my body do what it needs to do to prevent an autoimmune breakdown of my myelin.

4. Sometimes people are wrong – Nixon was wrong.

If the good people, in their wisdom, shall see fit to keep me in the background, I have been too familiar with disappointments to be very much chagrined.” – Abraham Lincoln (1809-1894), (p 634, I.23)
Hemp fiber was essential for rope and strong fabric. Thomas Jefferson grew hemp and is said to have smoked it too. It is time to stop being disappointed in loved ones who are likely suffering from a metabolic deficiency that leaves them susceptible to substance abuse or overeating and instead start accepting that they have needs that a person of average health doesn’t have or may not have to the same extent. Many nutrients are needed in a just right amount, not too little or too much.
     Cannabinoids are powerful and can be consumed in excess however it does not have the toxicity and deadliness of many other substances that are abused, including alcohol.
     The American Medical Association has recommended that marijuana be rescheduled as an herb with medicinal benefits. (I.24.AMA resolution) (I.25.veteransformedicalmarijuana)
     Rescheduling marijuana as a medicinal plant would free academic researchers to study its medicinal benefits. As a “Scheduled Substance” currently research studies are only supposed to assess toxicity and rehabilitation areas rather than design experiments assessing the medicinal value. Currently the synthetic form of the main euphoric cannabinoid, THC, is listed at a “safer” level of risk than the marijuana plant itself.
     The synthetic forms can be even more dangerous as they are more concentrated and are in isolation rather than also providing the non-euphoric cannabinoids that are found in most strains of marijuana and which have calming effects. Synthetic THC or THC in excess can cause paranoia and other mood symptoms that would have been unknown to Thomas Jefferson when he enjoyed smoking marijuana that was milder in the amount of THC it likely contained and more likely to be balanced with non-euphoric cannabinoids.
     The problem with black market development of a product is that it is often being designed to maximize the “buzz” or “euphoria” rather than the medicinal or pain killing effects. However, there is not that much “euphoria” felt by the person with chronic illness who is using a larger quantity of marijuana everyday due to an underlying inability to make cannabinoids because a tolerance is built up and they simply need some of the herb or other concentrated sources of cannabinoids every day just to maintain a state of health and function that is a little closer to everyone else’s “normal function“.    

     The person with a chronic need wants an herbal medicine that has a balanced variety of cannabinoids that treats a variety of symptoms, not just the euphoria inducing THC that can lead to overdose symptoms of a racing heart, feeling very chilled, and paranoia or anger combined with extra energy, so manic behavior might be a risk with an overdose reaction. Real lime or lemon juice products that are concentrated rather than being a watery lemonade may help counteract some of the mood changes associated with an overdose of THC. More on lemon oil is included in the next section. 

5. Medical Marijuana helps reduce opioid use, which can save lives.

     We currently have an epidemic of deaths due to opioid medications, prescription and black market drugs. The increase in deaths is due in part to the over prescription of opioid painkillers by the medical community but it is also due to black market substitutes that have been introduced in recent years. One type is particularly potent and is being sold as something else so consumers wouldn’t even know that they were being given a stronger version of an opioid medication than the prescription medication they were told they were purchasing on the black market – key point – don’t buy drugs on the black market because you don’t know what they might contain.
     This likely seems an obvious point which, honestly, even the drug addict knows that but their need is great enough during withdrawal that they may be more likely to take risks.
     Women may be especially at risk for opioid addiction whether it is due to differences in size or physiology is unknown. Addiction to opioids seems to occur for women at lower doses of the medication that were taken for a shorter amount of time than for men who become addicted. Women may be more susceptible to the cravings for the drug. (I.27.jotopr)
     In states with medicinal marijuana sales of painkillers dropped,which would include the opioids. Physicians are not comfortable with the inability to “prescribe” a set dose. “Take two hits and call me in the morning?” was asked in jest or in seriousness by a psychiatry professor, Deepak D’Souza, who also has researched marijuana. (I.28.npr)
     Deaths due to overdoses of opioids have also decreased in those states. (I.29.nbcnews) The cannabinoid and opioid receptor systems may both be involved in the regulation of appetite. Levels of the hormone leptin may be increased in response to CB1 receptors in the hypothalamus. Leptin and other appetite hormones may then “control opioid-regulated feeding…(Verty et al., 2003).” See Ch.13: Behavioral Effects of Endocannabinoids, (p313, I.10.Endocannabinoids.Full Text.pdf).
     Since marijuana use seems to be saving lives and has low toxicity risks, it doesn’t seem like how big a dose is as big a question as how to get a safe reliable supply to more patients in pain. The answer does exist but it is one a physician or psychiatrist is unlikely to like – the dose varies based on the person’s genetics and metabolism, the supply of nutrients available, tolerance, etc.; the answer is “It depends.” But the medication is so safe that worries about “too much” are really unnecessary, except possibly for more concentrated synthetic sources or extracted cannabinoid oil products.
     Signs of “too much” THC or synthetic THC can include a racing heartbeat, which very, very rarely has caused a couple/very few deaths. To the user first experiencing the racing heartbeat of excess THC, it may be frightening and feel like a panic attack. Relax it slows down again and only people with a pre-existing heart condition may be at risk during the time that the heart-rate is rapid.
     So if you have a weak heart – avoid excessive amounts of THC. The rapid heart-rate doesn’t occur at low doses. It may be accompanied a feeling of being chilled, and suddenly needing a jacket. Anxiety or anger may occur with excess THC or synthetic THC or during withdrawal from an excessive amount.
     The aromatic terpenes in citrus oil can have a calming effect if anxiety is a problem after consuming marijuana. Pinene from pistachio nuts may also be helpful, but a glass of lemonade might help the mood more quickly than eating pistachios because they would take longer to digest. (I.26.fastcompany)
     Artificial lemon flavored products wouldn’t help, only real lemon or lime juice products would help calm a mood unsettled by an excess or imbalance of THC. The plant contains many active phytochemicals which can include terpenes and other cannabinoids that are calming to the mood rather than causing euphoria. THC is the only cannabinoid in marijuana that causes euphoria.
     Opioid medications also cause euphoria – so why is one more socially acceptable than the other? Smoking is dirty and smelly and – the easiest way to not overdose.
     Eating products or the concentrated synthetic dose in one single sitting can leave a person feeling symptoms of overdose about one hour later, far too late to stop at half a serving or a small taste to see how you might handle that particular product and/or the strain that was used in it. Different strains of the plant can cause very different symptoms and help different types of symptoms, so the question of “how much” is less significant than which strain to use and the method to use to consume it.
     Smoking provides fairly instant changes to the mood so it is easy to tell if you’re getting more anxious or developing a rapid heart rate. Strains of marijuana can vary a lot, some types may cause the anxiety symptoms, while others would just cause the stereotypical “couchlock” – falling asleep. While setting fire to the couch might be a very real risk, otherwise, no danger other than possibly drooling a little and looking stupid. Looking stupid is better than looking dead from an opioid overdose – in my opinion – and I am a medical marijuana patient who has experienced these symptoms and read research about safe use.

6. Resources for help or just someone to talk to:

  • National Helpline: Substance Abuse and Mental Health Services Administration: “SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service), is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.” (1.30samhsa.org)
  • Rape, Abuse and Incest National Network, RAINN Hotline: 1-800-656-HOPE, (1.31RAINN.)
  • U.S. National Suicide Prevention Hotline: “Call 1-800-273-8255, Available 24 hours everyday.” (1.32.suicidepreventionlifeline.org)

Help is only helpful when you accept it. Recognizing that you need it is the first step.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Links and References:

(I’ll finish this list later, I’ve learned a lazy editing tactic is to skip the footnote numbers until the final draft is complete.)

  1. Disease,” Oxford Dictionaries (I.1.disease)
  2. BHMT,” wikigenes.org, http://www.wikigenes.org/e/gene/e/635.html (I.wikigenes.BHMT)
  3. Glycerophospholipid biosynthesis,
  4. metabolism ,
  5. Phospholipid metabolism,
  6. (I.6.genecards.BHMT) [http://www.genecards.org/cgi-bin/carddisp.pl?gene=BHMT] (I.6.genecards.BHMT)
  7. (I.7.genecards.phosphorylation) [http://pathcards.genecards.org/card/cdk-mediated_phosphorylation_and_removal_of_cdc6] (I.genecards.phosphorylation)
  8. Leukotriene,” (I.8.scbt.com)
  9. Behavioral Neurobiology of the Endocannabinoid System; Ch.13: Drug Addiction, (page 334, I.9.Searchworks)  Behavioral Neurobiology of the Endocannabinoid System, Editors David Kendall and Stephen Alexander (Springer, 2009, Nottingham, U.K.). (I.Searchworks)
  10. Endocannabinoids: The Brain and Body’s Marijuana and Beyond, (CRC Press, 2006, Boca Raton, FL), Chapter Three, Endocannabinoid Receptor Genetics and Marijuana Use, editor and chapter by Emmanuel S. Onaivi, et al., (pages 72-73, 91, and 333), Chapter 15, Neuropsychiatry: Schizophrenia, Depression, and Anxiety, chapter by Ester Fride and Ethan Russo, (page 378), (I.10.Endocannabinoids: FullText pdf)
  11. (I.11.sciencedaily) Genetic risk factor for binge eating discovered. Sciencedaily.com, Oct. 26, 2016,  https://www.sciencedaily.com/releases/2016/10/161026170543.htm (I.sciencedaily)
  12. (I.12.ncbi.FragileX) Sabiha Abekhoukh and Barbara Bardoni, CYFIP family proteins between autism and intellectual disability: links with Fragile X syndrome, Front Cell Neurosci. 2014; 8: 81., ncbi.nlm.nih.gov https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973919/ (I.ncbi.FragileX)
  13. (I.13.reuters) Pathway Maps: G-protein signaling_RAC1 in cellular process, Life Sciences Research, thomsonreuters.com, http://lsresearch.thomsonreuters.com/maps/383 (I.reuters)
  14. (I.14.genecards.CYFIP2) CYFIP2, genecards.org,  http://www.genecards.org/cgi-bin/carddisp.pl?gene=CYFIP2 (I.genecards.CYFIP2)
  15. (I.15.omicsgroup) Shahla Mohamadirizi1*, Vahid Shaygannejad2, Soheila Mohamadirizi3 and Marjan Mohamadirizi4, Eating disorders in a multiple sclerosis clinical population and its association with social anxiety.   https://www.omicsgroup.org/journals/eating-disorders-in-a-multiple-sclerosis-clinical-population-and-its-associationwith-social-anxiety-2376-0389-1000183.php?aid=82623 (I.omicsgroup)
  16. (I.16.sphingolipids)
  17. (I17..mpcfaculty.lipids)
  18. (I.18.coconut) Handbook of Plant-Based Fermented Food and Beverage Technology, Second Edition, edited by Y. H. Hui, E. Özgül Evranuz  CRC Press, May 17, 2012, https://books.google.com/books?id=5fvRBQAAQBAJ&pg=PA669&lpg=PA669&dq=sphingolipids+in+coconut&source=bl&ots=QlgC46XLn8&sig=Y5AiDM4oUTBp9BS3aOKCtWK0Fbk&hl=en&sa=X&ved=0ahUKEwiQuL-wmdbVAhUG7CYKHXZCCxsQ6AEILjAB#v=onepage&q=sphingolipids%20in%20coconut&f=false
  19. (I.19.BMHT.MS) Naveen Kumar Singhal, et al., Changes in Methionine Metabolism and Histone H3 Trimethylation Are Linked to Mitochondrial Defects in Multiple Sclerosis. J of Neuroscience Vol 35, Issue 45, 2015 PAGES: 15170-15186 ISSN: 0270-6474 https://www.researchgate.net/profile/Rohan_Dassanayake2/publication/283710653_Changes_in_Methionine_Metabolism_and_Histone_H3_Trimethylation_Are_Linked_to_Mitochondrial_Defects_in_Multiple_Sclerosis/links/5693c64508aeab58a9a2aaf3.pdf (I.BMHT.MS)
  20. (I.20.wikigenes)
  21. ( methionine )
  22. ( Dimethylglycine (DMG).
  23. John Bartlett, Familiar Quotations, 14th Ed., 1910, (p 634, I.23)
  24. (I.24.AMA resolution) American Medical Association Medical Student Section, Resolution 2, JUne 8, 2008, http://www.oregon.gov/pharmacy/Imports/Marijuana/Public/AMA_MedStudentSectionResolution.pdf (I.AMA resolution)
  25. (I.25.veteransformedicalmarijuana) AMA Votes to Reschedule Medical Marijuana, VMCA, http://www.veteransformedicalmarijuana.org/node/67 (I.veteransformedicalmarijuana)
  26. (I.26.fastcompany) Chris Dannen, Three Beginner Mistakes to Avoid When Eating Cannabis, fastcompany.com Sept. 10, 2014, https://www.fastcompany.com/3035175/three-beginner-mistakes-to-avoid-when-eating-cannabis (I.fastcompany)
  27. (I.27.jotopr) Karen Barth, New Study Shows Women are Hit the Hardest as Opioid Epidemic Sweeps the Country. Jotopr.com, Feb. 27, 2017, https://jotopr.com/new-study-shows-women-are-hit-hardest-as-opioid-epidemic-sweeps-the-country/?utm_source=ReviveOldPost&utm_medium=social&utm_campaign=ReviveOldPost (I.jotopr)
  28. (I.28.npr) Shefali Luthra, After Medical Marijuana Legalized, Medicare Prescriptions Drop for Many Drugs. npr.org, July 6, 2016, http://www.npr.org/sections/health-shots/2016/07/06/484977159/after-medical-marijuana-legalized-medicare-prescriptions-drop-for-many-drugs (I.npr)
  29. Reuters, Legalized Marijuana Could Help Curb the Opioid Epidemic, Study Finds. March 27, 2017,nbcnews.com,  http://www.nbcnews.com/health/health-news/legalized-marijuana-could-help-curb-opioid-epidemic-study-finds-n739301 (I.29.nbcnews)
  30. National Helpline: Substance Abuse and Mental Health Services Administration: 1-800-662-HELP (4357), (1.30samhsa.org)
  31. Rape, Abuse and Incest National Network, RAINN Hotline: 1-800-656-HOPE, (1.31RAINN.)
  32. U.S. National Suicide Prevention Hotline:  1-800-273-8255, (1.32.suicidepreventionlifeline.org)
  33. Amy Yasko, Nutrigenomic Testing, Holistic Health International, http://www.holisticheal.com/health-tests/nutrigenomic-testing (I.33.Nutrigenomic Screening)
  34. Amy Yasko, Methylation Analysis Pathway: John Doe, Neurological Research Institute, http://www.holisticheal.com/media/wysiwyg/John_Doe_MPA_05.19.17.pdf (p22, I.34.example of the genetic screening I had)

Autistic kids wash up happier in an Epsom salt bath

***What should autistic kids eat? For some of them weight gain is a problem and the short term answer is anything they are willing to swallow. With time and patience more variety may be accepted but the children may be avoiding some foods because they make them feel worse. forcing a “balanced diet” from all food groups may not be in their best interests. Food sensitivity testing can identify more types of sensitivities that traditional allergy tests miss.The following article provides physiologic guidance towards why some foods may be preferred or despised. Allergens can have an addictive effect due to an opioid like reaction. We can crave what is good for us but we can also crave what is bad for us – it can be exciting physiologically speaking. Some of the chemicals that build up can have neurotransmitter activity in the brain – literally over stimulating the brain cells. Can bananas and tomatoes kill brain cells? Not in everybody but maybe in autistic bodies overloaded with toxins.

Excerpts from: Autism, an extreme challenge to integrative medicine. Part II: medical management. 
by Parris M. Kidd

Magnesium sulfate (Epsom salts) can benefit the autistic child through a novel route of delivery. A parent reported her child’s oppositional behavior disappeared overnight after a bath in Epsom salts. (67) Other parents who used the treatment soon reported improvements in speech, mood, cooperation, and motor development.
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*** Over soaking in an Epsom salt/magnesium sulfate salt bath can lead to too much absorption of magnesium and produce temporary side effects of a fluttery/weak heart and possibly diarrhea. A soak for 20 minutes to 40 minutes at the very most seems an effective time for me. I use about 1-2 cups of the Epsom salt to a full bath.

I have also been adding a little vitamin C powder or spoon of cooking vinegar to balance the pH. The Epsom salt gives about an 8 pH and a 7 is more skin and hair friendly. I use pH strips to check the acidity after adding a little vitamin C powder or cooking vinegar (apple cider vinegar leaves me smelling like apple pickles). Kids and all of us love a hot bath, however warmish is better for the body than too hot. Pruney, wrinkly finger tips can be a easy sign for children to see for themselves – the body absorbed as much extra fluid as it can hold and now the skin is all ripply – cool and cold, water and cool, wrinkly fingers means its past time to get out of the tub.    [17,18: links about Epsom salt baths]
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Vitamin B6 and Magnesium (excerpt con’t, by Parris M. Kidd)
Vitamin B6, in its active form of pyridoxal-5-phosphate (P5P), is an essential cofactor for a majority of metabolic pathways of neurotransmitters, including serotonin, gamma-amino-butyric acid (GABA), dopamine, epinephrine, and norepinephrine. Magnesium is an essential macronfineral required for a wide range of enzyme-catalyzed metabolic pathways. Rimland recently reviewed 18 autism studies conducted with vitamin B6, especially in combination with magnesium, (22) and concluded that all provided positive results with no significant adverse effects. While no cures of autism by vitamin B6 are known, many cases of remarkable improvement have been documented.

A 1988 paper by Rimland provided an in-depth review of the history of vitamin B6 for autism. (29) In 1966, Heeley and Roberts reported vitamin B6 corrected abnormal tryptophan metabolism in 11 of 19 autistic children. (30) In 1968, Bonisch (cited in Rimland, 1988 (29)) reported vitamin B6 (100-600 mg per day) improved behavior in 12 of 16 autistic children. According to Rimland, three of Bonisch’s subjects spoke for the first time while participating in this open trial.

After conducting an exploratory, non-controlled study in the early 1970s, (31) in 1978 Rimland published the findings from a small double-blind trial that involved 15 children with autistic symptoms. (32) In this trial only half the children involved qualified as ASD by current criteria. (32) In this crossover trial, each child received vitamin B6 at a dose of 2.5-25.1 mg/kg body weight/day (75-800 mg per day) or a placebo. Following a complex, five-phase protocol, each child continued taking whatever vitamins, minerals, or drugs they had been receiving prior to the study and the duration of B6 dosing was individualized. Rimland stated they also received “several hundred” mg per day of magnesium and a B-complex vitamin to guard against overdosing with B6. (22) Statistically significant benefits emerged from this trial, including better eye contact, less self-stimulatory behavior, more interest in surroundings, fewer tantrums, and better speech. (32) Rimland began to suspect for many children autistic symptomatology might be a type of vitamin B6 dependency syndrome. (29)

Taken together, the studies seem to establish that vitamin B6 can benefit as much as half of children and adults with autism, and that its efficacy and safety are improved when combined with magnesium. None of these studies reported any significant adverse effects, even though the vitamin B6 doses ranged as high as 1,000 mg per day. Rimland emphasized that thousands of autistic people have been taking large daily doses of vitamin B6 (as much as 1,000 mg) for decades without experiencing problems. One publication reported on seven cases of peripheral neuropathy from daily intakes of more than 2,000 mg vitamin B6. (37) These patients were not taking magnesium or other B vitamins, as usually recommended when taking large vitamin B6 doses; nor were they taking the active form–P5P–that has not been associated with toxicity. In a later study, doses of 30 mg/day of B6 as pyridoxine hydrochloride (equivalent to as much as 2,100 mg for a 70 kg adult) were administered with 10 mg/kg/day of magnesium lactate to 11 autistic children for eight weeks; behavior significantly improved and no adverse effects were evident. (38) The latest ARI parent ratings in 2002 (24) reported a B:W ratio for vitamin B6 used alone of 4.1:1, for magnesium alone 5.2:1, and for the combination of vitamin B6 plus magnesium, 11:1.

Cases of hereditary impairment of pyridoxine metabolism have been described, sometimes manifesting as seizure disorder and autism symptomatology. (39) Conversion of vitamin B6 to its active form P5P by the liver can be compromised in some autistic children. For these cases P5P supplementation may work more effectively, although hyperactivity is a possible adverse effect. (40) An intake threshold for achieving benefit may be approximately 200 mg vitamin B6 (as pyridoxine) and 100 mg magnesium per day for the 70 kg individual. (41) In any case, the cumulative results from the double-blind trials and numerous other studies and case history reports are consistent with impressive efficacy of the combination of vitamin B6 and magnesium for autism, superior to either nutrient alone. (38,42-44)

Vitamin C
Vitamin C has a reputation for its involvement in a plethora of metabolic, antioxidant, and bio-synthetic pathways, and as a cofactor for certain enzymes necessary for neurotransmitter synthesis. In a double-blind trial for 30 weeks, vitamin C (8 g/70 kg body weight/day) improved total symptom severity and sensory motor scores. (50) Its current parent B:W ratio is an excellent 16:1, from 1,306 questionnaires.

(***That is an awful lot of vitamin C but it is water soluble and is not stored. We need it daily. The B vitamins are also water soluble and non-toxic. “Expensive pee” is the joke but if it is helping the body on the way through than it isn’t that expensive compared to ill health.)

Zinc
Among its many functions, zinc is needed for the development and maintenance of the brain, adrenal glands, GI tract, and immune system. Serotonin synthesis relies on zinc-activated enzymes; and zinc is also essential for antioxidant enzyme activity and other proteins important for growth and homeostasis. Breeding experiments with rodents indicate a zinc deficiency in the mother can be passed on to the offspring and negatively influence immunity and brain development. (51) Zinc currently has a very favorable B:W ratio, 17:1 from 835 questionnaires.

Zinc operates in a relationship with copper, i.e., when zinc levels go down, copper levels often go up. Bradstreet and Kartzinel assert zinc is deficient in 90 percent of ASD cases and copper in excess in 90 percent of cases. (14) Walsh analyzed copper and zinc in the blood of 318 ASD subjects and reported finding abnormally elevated copper:zinc ratios in 85 percent. (52) A smaller sampling of 22 subjects had 100-percent incidence of abnormally high, unbuffered copper (unbound to ceruloplasmin proteins)–about four times normal. Walsh’s findings corroborate recommendations by Adams (25) and others that autistics should exclude copper from their multiple vitamins.

(***Minerals can be dangerous at chronically high doses and the balance can be crucial. Wilson’s Disease is a copper overloading disease caused by a genetic defect. Pumpkin seeds, the green shelled part, are an excellant source of zinc and can be crisped by lightly toasting them in a skillet. Pepitos are another name for the Mexican snack version. Pre-toasted and salted pepitos can be quite salty unless you find raw pumpkin seeds at a health food store.)

Essential Fatty Acids Studies on EFA deficiency in autism are few, but with consistent results. Bradstreet and Kartzinel found omega-3 fatty acids are deficient in nearly 100 percent of ASD cases. (14) Vancassel and collaborators reported DHA 23-percent reduced, total omega-3s 20-percent reduced, and omega-6s unchanged in plasma phospholipids. (57) Hardy and Hardy studied 50 children with the more inclusive diagnosis Pervasive Developmental Disorder (PDD), and reported almost 90 percent omega-3 deficient via red cell analysis. (58)

Amino Acid Abnormalities
At least two-thirds of autistics have abnormal amino acid levels, as measured in 24-hour urine or lasting blood plasma. High phenylalanine is rarely seen (one per several thousand autistics) but can occur without overt phenylketonuria (PKU), which may be observed in children from countries that do not test for PKU at birth. High histidine (histidinuria and usually concurrent histidinemia) is seen in one per 250-500 autistics, and also can mimic autism. High urine levels of several amino acids (generalized hyperaminoaciduria) almost always indicate toxic chemical exposure and consequent liver damage. Such is also attributable to heavy metal contamination and Wilson’s disease, Fanconi syndrome, cystinosis, fructose intolerance, galactosemia, and several other hereditary disorders. (6)

Low urine threonine suggests malabsorption. In maldigestion, anserine and carnosine are high, while the essential amino acids are low. Anserine and carnosine may also be high due to zinc insufficiency. When citrulline, methionine, ethanolamine, and phosphoethanolamine are elevated, functional magnesium deficiency is likely. Elevated sarcosine indicates toxic exposures and/or folate deficiency. And, when detoxification capacity is limited, the cysteine/cystine ratio, and methionine, taurine, and glycine levels tend to be abnormal.

Amino Acid Abnormalities
Autistic subjects who poorly metabolize tryptophan can carry its potentially toxic metabolite indoylacrylic acid (IAA) in their blood. IAA would normally be detoxified by combining it with glycine to make indoylacryloylglycine (IAG). Organophosphate pesticide contamination may shunt tryptophan down the IAG pathway. (6) Tryptamine, found in tomatoes and all types of bananas, may also raise IAG levels. Certain citrus fruits also may contain tryptamine-like substances. Assays for IAG are not routinely available and are easily contaminated.

(***Tryptamine may act as a neurotransmitter and is part of tryptophan, melatonin, serotonin and the psychoactive chemical in Psilocybin mushrooms and LSD. Tomatoes and bananas may not be good for some autistic people due to an enzyme defect and removing dairy protein and wheat protein improved symptoms for up to 80% of ASD subjects.)

Removing Casein and Gluten Foods from the Diet
There is a great deal of evidence that foods containing casein or gluten contribute significantly to ASD and should be eliminated from the diet. In well-conducted studies, as many as 80 percent of ASD subjects improved following strict dietary exclusion of these proteins. (13,14) Implementation of a strict casein- and gluten-free (CFGF) diet almost always leads to symptomatic improvement, and lays the foundation for a diet that can markedly benefit the condition.

It has been suggested that the adverse brain effects associated with dietary casein and gluten are likely due to opioid-acting peptides (small amino acid polymers, also called exorphins) metabolically generated from these proteins. (15) In their Sunderland Protocol for autism, Shattock and Whiteley note that clinical improvement often occurs on the CFGF diet even when laboratory tests fail to detect such peptides in the urine. (14) They suggest autistic subjects could be biochemically processing casein and/or gluten into other bioactive derivatives not being detected; or, while urinary levels measure normal, the quantities reaching the CNS could be high, perhaps due to abnormal permeability of the blood-brain barrier. Yet another possibility they suggest is children subjected to oxygen deprivation or other perinatal brain insults may have heightened vulnerability to even “normal” levels of the offending peptides.

Reichelt et al studied 15 ASD subjects (5 girls and 10 boys, age 3-17 years) for one year after implementing casein and gluten restriction. (16) They reported that 13 of 15 showed some degree of behavioral improvement and none got worse, as judged from parent-teacher consensus. Seizure activity was decreased in 3 of 4 subjects; gross motor behavior improved in 13 of 15; social contact increased in 10 of 15; eye contact improved in 9 of 15; ritualistic behavior decreased in 8 of 11; language improved in 10 of 13; and sleep patterns normalized in 9 of 11. These investigators concluded that incomplete digestion of casein or gluten-gliadin by digestive peptidase enzymes could be a biochemical cause of autistic syndromes.

Since abrupt simultaneous removal of casein and gluten from the diet can cause withdrawal symptoms, a two-step phased withdrawal is appropriate. The first phase is removal of casein via removal of milk and other dairy products. From a 1995 trial, Lucarelli et al reported 66 percent of subjects showed benefits from this intervention. (17) Benefits can manifest quickly–usually within 2-3 days in young children or 10-14 days in adults. However, a much longer period is required for casein to be fully cleared from the body.

Shattock and Whiteley documented the known metabolic dangers to children from consuming cow’s milk. (14) Milk consumption is linked to increased autism incidence among the immigrant population in Sweden as compared to the indigenous population. (18) Some children are clearly addicted to cow’s milk and will drink large quantities. Symptoms linked to casein intake include projectile vomiting; eczema, particularly behind the knees and in the crook of the elbow; white bumps under the skin; ear discharges and infections; constipation, cramps, and/or diarrhea; and respiratory disorders resembling asthma. Shattock and Whiteley report that casein withdrawal symptoms can be severe, especially in young children. (14)

Some higher-functioning ASD children voluntarily cease casein intake, apparently sensing it is not good for them. Gluten products, on the other hand, stir strong cravings and children are less likely to refuse them. (19) Gluten exclusion requires the removal of several common cereals from the diet, wheat, barley, rye, and oats, in particular; but many other foods contain hidden gluten. (19-21) The elimination process usually takes a minimum of 3-4 weeks, and a trial period of three months is appropriate. The urinary gluten profile persists for much longer than does the casein profile, and correspondingly the withdrawal effects are usually milder in severity than casein’s, but typically more prolonged.

Full clearance of dietary casein-gluten symptoms is a long-term process. Withdrawal can be evident for three months or longer. (16) Whiteley’s group (19) found a mere 26-percent reduction in urinary levels of gluten after a five-month exclusion diet. In some cases dramatic improvement emerged a full 7-9 months after initiating the diet, but maximal improvement can require up to two years of rigid dietary exclusion. Shattock and Whiteley advise against adding these foods back into the diet, since severe opioid symptoms could result. (14)

Sensitivities to Other Foods
Whereas children with neurodevelopmental disorders frequently have sensitivities to common foods, ASD children seemingly have extreme sensitivity to a wide range of foods. These sensitivities may contribute to the perceptual and processing difficulties that typify autism, yet are difficult to objectify. The classic allergy symptoms such as stuffiness, eczema, wheezing, and itching may be absent, yet cognition and behavior remain affected. (2)

Once the main sources of food intolerance–casein, gluten, and gliadin–are removed from the diet, other foods may emerge as sources of symptoms. Parents, particularly those who keep food diaries, can often associate the child’s consumption of a particular food with deterioration in behavior, sleep patterns, or performance. Beef, pork, rice, and potatoes are only occasionally implicated; whereas, foods that consistently cause problems are eggs. tomatoes, eggplant, avocados, red peppers, soy, and corn. Seroussi (21) described how corn was revealed as a problem food only after strict removal of gluten and casein from the diet. If a particular food is suspected, it should be removed from the diet for a trial period of at least three weeks and any improvements noted. On being reintroduced into the diet, it will likely trigger an exacerbation of symptoms.

1. Kidd, Parris M.. “Autism, an extreme challenge to integrative medicine. Part II: medical management. (Autism).(Brief Article).” Alternative Medicine Review. Thorne Research Inc. 2002. HighBeam Research. 14 Mar. 2011 <http://www.highbeam.com>.

*** Chocolate is the main food eaten by one little girl with autism spectrum disorder in a later link. As a dietitian in a public health program I have worked with several autistic children and “crisp” was a popular food group. I personally love Lundberg rice cakes because they are more dense and crispy than regular store brand rice cakes. A varied diet has benefits but excluding allergens and enzymatically indigestible foods has benefit as well. The chocolate itself is a healthy start but continuing to offer variety and to enjoy variety as a role model of healthy eating generally will help a child find more foods that help more than hurt.

The tomato and banana news surprised me – I don’t eat either after my migraine history. Both were early “avoids” and since becoming less sensitive I just haven’t enjoyed them much. Dairy is a big congesting no-no for me and I still avoid gluten in general. Rice feels better, and seems to help me think and move better.

Chocolate is an excellent source of minerals and B vitamins. A hundred grams of pure dark chocolate (no sugar or cream) contains 556 calories, 136 mg magnesium, 56 mg calcium, 559 mg potassium, 8 mg iron, 2 mg zinc, 1 mg copper, 1.4 mg manganese and 3 mcg selenium. It is also a good source of B vitamins and is one of the few known sources of cannabinoids. See the page Bbliography on iodine and autism for a little more info.

2. “SWEET RACHEL LIVES ON CHOCOLATE DIET; Autism feeds plight.(News).” Daily Record (Glasgow, Scotland). Media Wales Ltd. 2004. HighBeam Research. 14 Mar. 2011 <http://www.highbeam.com>.
3. “The little girl who can only eat chocolate; AUTISM GIRL’S FOOD FAD.(News).” The Mirror (London, England). Media Wales Ltd. 2004. HighBeam Research. 14 Mar. 2011 <http://www.highbeam.com>.
5. Garston, Helen. “Sad chocolate drop kid eats only 15 bags of buttons a day.(News).” The People (London, England). Media Wales Ltd. 1998. HighBeam Research. 14 Mar. 2011 <http://www.highbeam.com>.  (***This is a second chocolate eating autistic spectrum child. I’m not recommending a milk and chocolate diet. It is more an example of a craving that might have some physiologic basis.)

6. “It’s hard to cry for Kieran …we know it’s not what he would have wanted; Tribute to 10-year-old meningitis tragedy boy.(News).” Evening Gazette (Middlesbrough, England). Media Wales Ltd. 2011. HighBeam Research. 14 Mar. 2011 <http://www.highbeam.com>. **This is a different boy, autistic, loved chocolate, unfortunately died of meningitis.)

7. Javier Fernández-Ruiz, Rosario de Miguel, Mariluz, Hernández, Maribel Cebeira, and José A. Ramos,  Endocannabinoids : The Brain and Body’s Marijuana and Beyond, Chapter 11, Endocannabinoids and Dopamine-Related Functions in the CNS, (2006 by Taylor & Francis Group, LLC) ,  

“Previously, the existence of anandamide analogs in chocolate had been demonstrated (di Tomaso et al., 1996). It is thought that chocolate and cocoa contain N-acylethanolamines, which are chemically and pharmacologically related to anandamide. These lipids could mimic cannabinoid ligands either directly by activating CBRs or indirectly by increasing anandamide levels (Bruinsma and Taren, 1999).”

8.  http://www.nal.usda.gov/fnic/foodcomp/cgi-bin/list_nut_edit.pl   Nutrient Data Base # 19902:  Chocolate, dark, 45- 59% cacao solids
9. http://www.health.gov/DIETARYGUIDELINES/dga2005/document/html/chapter2.html

10. “Great Culinary News for Individuals with Autism.PRWeb Newswire. Vocus PRW Holdings LLC. 2010. HighBeam Research. 14 Mar. 2011 <http://www.highbeam.com>.

11. “Easy Steps to Convert Favorite Recipes to be Gluten (and Dairy) Free.PRWeb Newswire. Vocus PRW Holdings LLC. 2010. HighBeam Research. 14 Mar. 2011 <http://www.highbeam.com>.

12. Jessica Werb. “Sick to the stomach.” The Scotsman. ECM Publishers, Inc. 2000. HighBeam Research.14 Mar. 2011 <http://www.highbeam.com>.

13. Cormier, Eileen; Jennifer Harrison Elder. “Diet and child behavior problems: fact or fiction?(Primary Care Approaches)(Clinical report).” Pediatric Nursing. American Nephrology Nurses’ Association. 2007. HighBeam Research. 14 Mar. 2011 <http://www.highbeam.com>.

14. http://www.thecrystaltarot.com/articles/nutrition-articles/autism-treatment  Treating Autism with Stem Cells, Immune Support, Nutrition and Anti-fungals., David A Steenblock, M.S., D.O.

http://en.wikipedia.org/wiki/Tryptamine

15. http://www.med.umich.edu/umim/food-pyramid/dark_chocolate.html 
© copyright 2010 Regents of the University of Michigan – University of Michigan Integrative Medicine
Monica Myklebust, M.D. and Jenna Wunder, M.P.H., R.D. For questions and licensing information please call 734-998-7874 or email umim-hfp@umich.edu.
Excerpt:
The Healing Foods Pyramid™, created in 2005 and updated in 2009, is an illustration of a balanced way of eating in which food is regarded as a source of healing and nurturing rather than simply a way to gain energy.

Healing Foods Pyramid™

Dark Chocolate ImageDark Chocolate is included in the Healing Foods Pyramid™ as part of a balanced, whole foods, plant-based diet. This Food Pyramid emphasizes foods that nourish the body, sustain energy over time, contain healing qualities and essential nutrients, and support a sustainable environment.

What are the recommended servings per week?
Up to 7 ounces per week, average 1 ounce per day

16. http://magnesiumforlife.com/medical-application/magnesium-iodine-and-autism/ Magnesium, Iodine and Autism  Magnesium deficiency measured in 95% of 116 Polish children with ADHD: 78% low hair, 59% low RBC’s, 34% low serum.[7]”

17. http://magnesiumforlife.com/product-information/magnesium-chloride-vs-magnesium-sulfate/ Magnesium Chloride Vs Magnesium Sulfate  According to Daniel Reid, author of The Tao of Detox, magnesium sulfate, commonly known as Epsom salts, is rapidly excreted through the kidneys and therefore difficult to assimilate. This would explain in part why the effects from Epsom salt baths do not last long and why you need more magnesium sulfate in a bath than magnesium chloride to get similar results. Magnesium chloride is easily assimilated and metabolized in the human body.[1] However, Epsom salts are used specifically by parents of children with autism because of the sulfate, which they are usually deficient in , sulfate is also crucial to the body and is wasted in the urine of autistic children.”

/Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./