Full Transcript Opening: Mental Health Symptoms as Medical Clues 0:00 So what are the most important messages you want families and practitioners to take away about the biological basis of mental health issues and kids, 0:09 and where we're filling them? 0:11 I think the most important message is that sudden onset psychiatric symptoms in previously healthy children should trigger an infectious disease workout, 0:22 not just a psychiatric evaluation. 0:25 Illnesses do not appear overnight, but autoimmune encephalitis from infection does. 0:32 And unfortunately, psychiatry is one of the few specialties that we don't routinely run physiological tests or evaluate the primary organ, 0:39 which is the brain. 0:41 So we're failing these children by just accepting the psychiatric labels without investigating the root causes. 0:49 So when a child, like a 10-year-old, suddenly develops severe OCD literally overnight, that's not a psychiatric illness. 0:57 That's a medical illness affecting the brain. 0:59 So that child needs a medical workup. 1:01 not just a psychiatric evaluation. 1:04 And parents need to trust their instincts. 1:07 Parents know their kids better than anyone. 1:09 So if they've fundamentally changed after an illness or a camping trip or moved to a new area, push for infection testing, 1:20 regardless of what the first practitioner that they see says. 1:24 And then for practitioners, that paradigm shift needs to happen. 1:30 So start thinking of the brain as an organ that can become infected, that can become inflamed, not just a site of chemical imbalances. 1:39 This is Doctor Talks, real talk from real doctors on the issues that matter to you most. 1:48 Welcome back to Lime Bites, Rebuilding Immunity, Reversing Inflammation, and Redefining Recovery. 1:54 Today, we're exploring a deeply misunderstood but increasingly recognized phenomenon, the presentation of Lyme disease and other vector-borne infections 2:04 as psychiatric disorders. 2:06 From sudden onset OCD and anxiety to depression, rage, and even psychosis, what is often labeled as mental illness may in fact be the result of an inflamed 2:19 brain driven by persistent infections, immune dysregulation, and environmental triggers. 2:25 Joining us on this episode is Dr. 2:27 Zendi Moldenhauer. 2:29 a nationally recognized expert in pediatric functional psychiatry, and the founder of Arbor Health in Rochester, New York. 2:38 With over 25 years of clinical experience and advanced training in functional medicine, integrative psychiatry, and neuroimmune disorders, 2:47 Dr. 2:47 Zendi has become a trailblazer in uncovering the biological roots of mental health symptoms in both children and adolescents.
How Infections Drive Neuroinflammation 2:56 And this episode will break down how infections like Borrelia, Bartonella, and mycoplasma can drive neuropsychiatric symptoms through mechanisms like molecular mimicry, 3:07 microglial activation, and chronic neuroinflammation. 3:11 We'll also explore how environmental exposures like mold, gut dysbiosis, and nutritional imbalances compound these issues. 3:20 And most importantly, how a root cause integrative approach can bring clarity and healing where traditional psychiatry falls short. 3:29 This is Lyme Bikes. 3:30 Let true healing begin. 3:32 Thank you so much for being here, Zendi. 3:35 You know, you shared with me this alarming statistic that up to 40% of patients with Lyme disease alone, so not to mention co-infections, 3:45 are misdiagnosed with primary mental health disorders. 3:50 I knew it was big, but that number really blew my mind. 3:53 Well, thank you so much for having me. 3:55 And yes, I'm passionate about the subject and I look forward to our conversation. 3:59 Wonderful. 4:00 So let's start out by talking about how infections like Lyme, Bartonella and Mycoplasma can trigger neuroinflammation in the brain and what role the microglia 4:13 activation and cytokine of balance play in these psychiatric symptoms. 4:18 Well, that's a great question. 4:20 These pathogens essentially turn the brain's immune system against itself. 4:24 When Borrelia crosses the blood-brain barrier, which as you know can happen within 24 hours of being bitten, it activates the resident immune cells called 4:35 the microglia. 4:37 The microglia cells are the brain's first responders to injury and disease and they constantly are surveilling the brain environment, 4:46 acting like a sentinel to detect the pathogen and repair cellular damage and other threats. 4:52 So in response to this injury or infection, the microglia become activated and they release lots of pro-inflammatory cytokines like IL-1-beta, 5:04 TNF alpha, IL-6 resulting in that neuroinflammation. 5:10 So here's the devastating cascade. 5:12 This inflammation hijacks tryptophan metabolism through the chironine pathway, shifting the production from serotonin towards quinoloic acid, 5:24 which is literally neurotoxic. 5:27 Meanwhile, the chronic activation of those microglial results in this sort of self-perpetuating cycle of neuroinflammation, 5:36 and that can exist way after the initial infection. 5:40 Now, Bartonella adds another layer by infecting the endothelial cells within the blood vessels, creating microvascular injury, 5:50 while mycoplasma, similar to strep, can trigger molecular mimicry, where the antibodies actually attack the neural tissue. 6:01 So the result, as you can imagine, is this perfect storm of inflammation that disrupts neurotransmitter synthesis, damages neural networks. 6:11 So suddenly, your dopamine, your serotonin, your GABA systems, the very chemicals that regulate mood, anxiety, and thought processes are completely thrown 6:22 off balance, and that creates the symptoms that we observe like depression, anxiety, and psychosis. 6:31 So as far as additional psychiatric symptoms like OCD, rage, anxiety, things like that, can you further explain how like this immune dysregulation can 6:44 actually cause symptoms like that? 6:47 Absolutely. 6:48 So children's developing immune systems make them particularly vulnerable to the inflammatory cascade. 6:56 Dr. 6:57 Jennifer Frankovich's research from Stanford Medicine shows that elevated levels of the cytokines directly correlate with the severity of OCD symptoms
Recognizing Infection-Driven vs Primary Psychiatric Illness 7:09 in parents' patients. 7:10 The basal ganglia, that deep part of the brain which control movement, behavior, emotions, are especially susceptible to this inflammation. 7:19 So when those cytokines cross the blood-brain barrier, they target those dopaminergic pathways in the basal ganglia, creating those repetitive behaviors 7:31 that we see in OCD. 7:34 Now, autoantibody production is particularly sneaky. 7:39 Through molecular mimicry, those antibodies, which are meant to fight strep or mycoplasma or Bartonella, cross-react with the neural tissue, 7:50 specifically targeting those dopamine receptors in the basal ganglia. 7:57 So this creates what's called autoimmune encephalitis that manifests as those acute psychiatric symptoms like OCD or acute or severe anxiety or even restrictive 8:12 eating that mimics eating disorders, severe depression, cognitive and behavioral changes. 8:18 And I've even seen catatonia and psychosis. 8:22 Now, when it comes to Bartonella, we see more rage. 8:26 Bartonella tends to involve disruption more of the frontal, prefrontal cortex. 8:33 And due to chronic neuroinflammation affecting the GABA and serotonin systems, we see that sort of more intense rage and anger. 8:43 But we've got to remember that this is not behavioral. 8:47 This is biological brain dysfunction. 8:51 Are you ready to revolutionize your approach to diagnosing and healing complex chronic inflammatory illnesses in both adults and children? 9:00 The Lime Bites Symposium is your gateway to cutting-edge education, groundbreaking research, and innovative therapeutic solutions. 9:07 Join us at the 2025 Lime Bites Symposium, November 14th and 15th at the Fort Lauderdale Marriott Pompano Beach Resort and Spa. 9:16 Lion Bites is the premier functional medicine conference on complex, chronic, infection-driven inflammatory illnesses. 9:24 This year's meeting is jam-packed with leading industry experts discussing lung COVID, mycotoxin illness, PANS Pandas, as well as Lyme and other vector-borne diseases. 9:34 This conference will arm you with the knowledge, clinical pearls, and practical solutions that you can implement immediately into your practice Monday 9:43 morning that will literally change your patient's lives and get them on their path to true healing. 9:48 So join us at Pompano Beach or virtually from anywhere. 9:51 Register now at LymeBytes.com. 9:54 That's L-Y-M-E-B-Y-T-E-S dot com. 10:00 So how do you, in the role that you're in, how are you able to distinguish between what is primary psychiatric illness and what is infection-driven? 10:13 Because as we're talking about, this goes way beyond Lyme. 10:18 This goes way beyond Borrelia. 10:19 There's all of these other vector-borne diseases, and then there's even a common, you know, bacteria strep that can, through molecular mimicry and other 10:33 immune dysregulation issues, you know, cause a lot of this abrupt onset of neuropsychiatric symptoms as well. 10:40 So how do you distinguish Oh, great question. 10:44 And we were talking ahead of time about the fact that up to 40% of Lyme patients initially receive a psychiatric diagnosis instead of proper Lyme identification 10:57 and treatment. 10:58 So it's absolutely staggering that most people, including many practitioners, have no idea that's happening. 11:06 The most common misdiagnoses that I see are ADHD-like cognitive changes where children are suddenly struggling with schoolwork or focus. 11:17 Now ADHD, remember, doesn't come on suddenly. 11:20 Usually you see symptoms that are there. 11:23 before five to seven years of age, we see that in kindergarten, we see that in preschool, we're not going to have a sudden onset of cognitive changes where 11:32 kids are suddenly struggling with schoolwork or focus, or sudden onset oppositional defiant disorder, or severe behavioral or mood dysregulation, 11:42 or out of the blue bipolar disorder, or OCD. 11:47 So the key differentiator here is the timeline. 11:51 These previously healthy children who develop symptoms acutely or subacutely over a period of days to weeks, we've got to be thinking not primary psychiatric disorders, 12:03 but rather something medical going on. 12:07 Primary psychiatric disorders simply usually have a more insidious or slower onset over months to even years. 12:17 Often there's a similar family history and infection-driven symptoms kind of come on out of the blue. 12:25 Often parents will say, you know, it's like an overnight change. 12:28 Suddenly their child becomes a completely different person over a short period of time. 12:33 The other thing that I think is important is primary psychiatric disorders don't usually come with a bunch of physical symptoms. 12:42 And so we've got to be looking for those physical clues like joint pain or headaches or fatigue or GI symptoms or enuresis, 12:54 you know, suddenly wetting the children suddenly wetting themselves either during the day or during the night, that's not common with a primary psychiatric disorder, 13:04 but it's really common with acute neuroinflammation of the brain. 13:08 So looking for those physical symptoms, I think, is really important because they suggest more systemic inflammation rather than the primary mental illness. 13:19 Another key feature I would say would be the cyclical nature. 13:24 Infection-driven symptoms often wax and wane, sometimes correlating with antibiotic treatment or some other immune system fluctuation,
Lyme, Bartonella, Babesia, and Mycoplasma Symptom Patterns 13:33 whereas primary psychiatric disorders tend to be more stable in their presentation. 13:39 And I think one other thing to think about is geographical or seasonal clustering. 13:45 When multiple children in the same area suddenly develop symptoms around the same time, we've got to be thinking infectious triggers. 13:53 It's not like OCD or depression has this sort of seasonal or geographic preponderance, but Lyme disease does. 14:04 I think when children walk into a primary care office or into a psychiatrist's office and then suddenly just gets put on psychiatric medication, 14:13 but then underlying infection is never addressed, it's like pouring gasoline onto a house fire. 14:22 It rages out of control without ever getting to that root cause, which I just think is just such a disservice to our children. 14:32 Yeah, absolutely. 14:33 And it's going to go on to manifest as other things as well. 14:36 Absolutely. 14:37 To recap for our listeners, so if we're trying to distinguish between an infection-driven psychiatric issue versus primary, 14:48 so infection-driven is going to be more abrupt versus slow onset. 14:55 We're also going to see other systemic symptoms, so other body or physical symptoms, even something like sweats, fevers, 15:05 chills, right? 15:06 It doesn't actually just have to be a pain syndrome. 15:10 Often, if it's infection-driven, symptoms will come and go, which is not typically seen with a primary psychiatric issue. 15:19 We can have geographic clusters that are infection-driven, like, for example, if COVID, for example, were the culprit, right? 15:27 So we might see it amongst groups of people. 15:30 And then another, a big one that we haven't talked about yet is failure to respond to the typical treatment of choice, right? 15:40 So if you were to put someone on a typical psychiatric medication, you know, that should work. 15:50 You don't see really any response or you might see an exacerbation. 15:56 So that's another big, big red flag. 15:59 Right. 16:00 Anything else to add to that list? 16:03 What is such a pity, Mariah, is just imagine the life course of somebody who's diagnosed correctly versus incorrectly. 16:15 And I see this over and over again with the kids that come and see me. 16:19 They have a particular diagnosis. 16:23 And if they're not treated correctly because of the underlying trigger, you can imagine that kid gets put on one psychiatric medication, 16:32 another, another, a hospitalization therapy, another psych med versus a kid that's correctly identified and you treat the underlying trigger like Lyme disease, 16:45 that kid gets better. 16:46 So it just for me is so heartbreaking to kind of imagine the life trajectory Not only for that child, but that family nearly even and their children. 17:00 And so that's why I wish more people knew to look for Lyme disease and tick-borne infections, other infections when, when children, 17:12 especially when they appear with kind of acute onset psychiatric symptoms. 17:18 Yeah, absolutely. 17:19 And to take it another step further, too, it doesn't just end with that person or with that family because there's vertical transmission. 17:29 So if these organisms are not dealt with and that girl goes on to become a woman and goes on to become pregnant and have a baby, 17:41 that infection can actually be passed. 17:44 transplantally to that baby now would be dealing with a case of congenital Lyme or another vector-borne disease, which is going to impact their body and 17:57 their health and their neuropsychiatric capabilities. 18:04 So tell us, what are the differences? 18:07 So do you see a different psychiatric presentation specifically amongst the infections? 18:14 So Borrelia versus Bartonella versus Mycoplasma versus Babesia versus say Strep? 18:22 Yeah, absolutely, I do. 18:25 So with Borrelia, also known as the great imitator, as you know, it creates what I call psychiatric Lyme with treatment resistant depression affecting 18:37 up to 60% of patients. 18:40 So those are the kids that just do not respond to typical antidepressants. 18:45 Another key feature for Borrelia is brain fog, really severe so people can't remember their own phone numbers or their math facts. 18:54 And suicide risk is double compared to the general population, often seen sleep disturbances and non-restorative sleep. 19:04 So the core cluster, I would say, for Borrelia, like classic line, would be cognitive dysfunction, executive planning issues, 19:14 word finding issues and feeling like people speaking about like they've suddenly lost 50 IQ points overnight. 19:23 What are some of the psych symptoms that you have seen in your patients with classic Lyme disease before I go on to the co-infections? 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PANS and PANDAS: Autoimmune Neuropsychiatric Syndromes 20:31 Lyme Core Botanicals, herbal medicine you can trust from a doctor who lives this work. 20:36 Learn more at Lyme Core Botanicals. 20:39 That's L-Y-M-E-C-O-R-E dot com. 20:48 I would say they're very, very similar. 20:51 So a lot of the depression, anxiety, not anxiety, you know, to the point that you would see it with babesia or bartonella, 20:59 not like this panic, but more like this low level of, you know, just you're anxious, but you don't really know about what, 21:08 you can't put your finger on it, but it's more of like a mild, right? 21:12 And then exactly, you know, executive functioning issues, issues following instructions, like simple instructions, you know, 21:21 like here's three or four steps. 21:23 And instead of, you know, being able to just say, OK, I'm going to go and do this. 21:27 It's like you keep referring back, like you can't remember what you just read or, you know, retaining like reading comprehension and things like that. 21:39 a lot of brain fog, a lot of, you know, feeling like things are just sort of swarming in your head and they don't stop. 21:47 And it's a lot of cognitive overwhelm, I think. 21:51 So you can imagine in children that looks like ADHD. 21:56 Yeah, not focusing, not remembering, needing repetition. 22:01 And that's completely, you know, that's not how ADHD suddenly appears, but that's a common misdiagnosis with classic Lyme disease because of that cognitive dysfunction. 22:12 Now compare that to Bartonella, which of course we know as the rage pathogen. 22:18 That's the one where parents will tell me their sweet eight-year-old suddenly is screaming, I hate you, I want to kill you and is raging and is punching 22:30 holes in the wall and a complete kind of personality change, if you will. 22:37 So the psychiatric triad there is this explosive intermittent anger, much more severe anxiety, often even with agoraphobic school avoidance, 22:50 and treatment-resistant depression that doesn't respond to SSRIs. 22:55 I also see more schizoaffective spectrum disorders with Bartonella, and then of course sleep problems as well. 23:03 And then remember that pathognomonic red stretch mark lesions in about 80% of cases with kids with Bartonella. 23:12 And obviously, we're not going to suddenly see those kind of stretch marks in a primary depression. 23:18 Like, we've got to be thinking what else is going on there. 23:21 But certainly, Bartonella, I see this angry rage out of control over any of the other tick-borne infections. 23:30 Yeah, I agree with you 100%. So with the bees here, I think of air hunger. 23:36 So patients will literally say that they feel like they're suffocating, even though their oxygen levels are normal. 23:44 So the tip off is when patients just say, I can't get enough breath. 23:48 I can't get a full breath. 23:50 Often we see more temperature dysregulation. 23:54 And then when with regards to the psychiatric symptom, far more anxiety, including panic attacks, ruminating anxiety, obsessive thoughts that loop endlessly 24:08 without resolution. 24:10 Yes, cognitive dysfunction as well, but more from their sort of intrusive thoughts and the inability to turn off their brain. 24:20 And when it comes to depression with babesia, there's much more of a sensation of despair and deep sadness. 24:30 and more than typical major depression. 24:35 It's just sort of a deep sadness that will often go. 24:40 Mycoplasma, I think of the most dramatic presentations like children with PANS, which is pediatric acute onset neuropsychiatric syndrome. 24:51 Literally kids can be waking up the next day or within a short period of time, like a two week period with severe OCD. 24:59 personality changes, school refusal. 25:02 And so that's sometimes similar to strep as well. 25:06 Mycoplasm and strep, I think, share that. 25:10 So the classic presentation is sudden onset obsessive-compulsive disorder, separation, anxiety, and academic regression. 25:19 I also sometimes will see tics, both motor and vocal tics, and then other um, symptoms like sensory symptoms or kids suddenly wetting themselves. 25:31 Um, what else do you see with, with mycoplasma in your adult population? 25:37 From a psychiatric perspective? 25:40 Um, I would say not much beyond what you've, you know, what you've described from a psychiatric perspective. 25:50 Yeah. 25:50 I, with the adult population, yeah, it's, it's not pretty similar. 25:55 pretty similar. 25:56 I see a lot more of respiratory issues, reproductive issues, a lot of micronutrient deficiencies, which obviously can lead to various psychiatric presentations 26:11 as well. 26:12 So as far as pans and pandas go, you know, we kind of danced around it.
Gut-Brain Axis, Testing, and Root-Cause Treatment 26:18 We talked about some of the diagnostic criteria. 26:22 Explain to our listeners, you know, take a step back. 26:24 What is pans and pandas? 26:27 And how and where do Lyme and other vector borne infections kind of fit into the broader spectrum of pans and pandas? 26:35 Well, PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with STRAP Infections. 26:44 So that was the originally described syndrome in the 1980s, and usually STRAP is the trigger. 26:53 But we now know that that syndrome can be triggered by many other infections that creates autoimmune neuroinflammation, including tick-borne diseases. 27:04 So PANS is a broader, bigger umbrella term that stands for pediatric acute onset neuropsychiatric syndrome. 27:15 So the criteria is broader than just strap, and there's no age limits as well. 27:20 So I've definitely seen PANS in adults, not only kids. 27:27 And In my practice, which is in upstate New York, a Lyme endemic area, I find that tick-borne infections feature in a large percentage, 27:37 like maybe even as high as 50%. And so I think it's super important when evaluating for pans and pandas that tick-borne infections, 27:48 both Lyme as well as The co-infections like Babesia, Bartonella, Ehrlichia, Anaplasma, Mycoplasma are all evaluated because they can all play a role in PANS. 28:02 The mechanism is similar, whether it's strep or Mycoplasma or tick-borne infections. 28:08 It's that molecular mimicry leading to those autoantibodies that attack the basal ganglion neurons. 28:16 So the end result is similar, which is autoimmune encephalitis presenting with all of those psychiatric symptoms we've just spoken about. 28:27 So it's recognizing that PANS is a syndrome, not just one diagnosis. 28:33 And we've got to be figuring out, I think of it nearly as like a triad, you know, like what is that infectious trigger? 28:41 Because we've got to identify that. 28:44 What is resulting in the inflammation that's ongoing and what is this piece that is that autoimmune reaction where the body is kind of getting hijacked 28:56 and attacking itself instead of attacking that primary trigger in the first place? 29:02 Right. 29:03 And so you have to resolve the primary trigger. 29:06 You also have to resolve the inflammation and basically rebalance the immune system in order to get that autoimmune process underway. 29:17 Correct. 29:17 Because you can remove the trigger, but if you don't fix the immune system, you're still going to be stuck in that loop. 29:25 Right. 29:26 And I think that's a mistake that's often made. 29:28 I think if the focus is just an antimicrobial, whether it's herbal or antibiotics, and that's the only focus, then you can get this recurrent situation 29:42 that doesn't resolve. 29:43 We have to take care of inflammation and that autoimmune process and heal the gut and restore nutrients and attend to detoxification. 29:56 So it's a complex syndrome to deal with. 30:01 It is. 30:02 It is. 30:03 And I think that goes for no matter what age you are. 30:06 And, you know, I would challenge anyone that, you know, it's going to be really hard to fully be able to evict any organism 100%. So maybe eradicate is 30:18 a better word. 30:19 You know, it's going to be hard to eradicate any organism without fixing the immune system, because in the end, It's not a certain combination or dose 30:33 or amount of time of being on any antimicrobial to your point, herbal or pharmaceutical, that takes an infection rate of anything to zero. 30:43 It's your immune system that comes in and eradicates an infection or holds it into remission. 30:49 So if we don't fix the immune system, we're not even going to be able to get rid of that primary infection. 30:57 When it comes to pandas, my thought process is that the reason why strep remains an issue is because of that underlying immune dysfunction or imbalance 31:13 that stops the body from actually being able to clear a strep infection in the first place. 31:19 Right. 31:20 All right, let's go back to Bartonella because it's one of my, when we're talking about psychiatric symptoms and implications, 31:28 Bartonella has to be one of the most fascinating infections. 31:33 So let's talk a little bit more about Bartonella and rage. 31:37 Do you see increasing attention on the psychiatric manifestations of Bartonella in particular. 31:44 And in addition to rage, what are the hallmark patterns that you see in these kits? 31:53 Well, rage is definitely a big piece of it, like literally, it's explosive, it's irrational, anger, it's out of character for that child. 32:06 Parents will often describe it like a jackal in high transformation where one moment their gentle child becomes violent over trivial triggers. 32:16 And then the other psychiatric fingerprint, I think, with Bartonella includes that severe anxiety, often with school refusal. 32:27 So, you know, you expect separation anxiety at certain predictable times during a child's life, like, you know, the 18 months to your age. 32:36 expected there. 32:37 You expect it around about kindergarten when kids are separating, but you're not expecting this in an eight-year-old or a 12-year-old or a 15-year-old. 32:47 So that separation anxiety, I think, is a hallmark as well. 32:54 And then just not responding to typical psychiatric medications, so there's treatment-resistant depression. 33:00 And then a lot of physical manifestations as well. 33:05 Kids will often complain of like ice pick headaches, sharp stabbing pains that come and go, sleep disturbances, vivid nightmares, 33:15 night terrors. 33:17 And then it affects them cognitively. 33:20 So these children develop severe attention deficits and executive dysfunction. 33:26 So teachers will complain like, Previously, excellent students suddenly can't focus, suddenly don't know their math facts, 33:35 suddenly can't comprehend with reading or follow those multi-step directions. 33:42 And the symptoms, because Bartonella is so sneaky, it can hide in those endothelial cells within the blood vessels, It can stay there sort of smoldering 33:53 and having this chronic infection and those symptoms can persist for many years. 33:59 So when treated, we can see this awesome transformation. 34:04 I've seen kids go from like psychiatric hospitalization to completely normal functioning within months of targeted and appropriate antimicrobials. 34:20 So how did gut health and intestinal permeability influence the neuroimmune responses in these patients? 34:27 And you can expand this from Bartonella into Lyme and other vector-borne diseases as well. 34:33 So the gut-brain axis is absolutely critical in any of these cases. 34:39 Chronic infection results in what we call leaky gut or increased intestinal permeability that allows those bacterial toxins and incompletely digestive 34:51 proteins from like casein from milk or gluten from wheat to enter systemic circulation. 34:57 further driving inflammation and the misdirected autoimmune response. 35:03 So I think of any autoimmune condition really beginning in the gut. 35:09 Often I'll see severe dysbiosis. 35:13 So dysbiosis meaning an imbalance between good and bad bacteria. 35:20 Often, a loss of those protective bacteria, especially bifidobacterium and lactobacillus, are often severely depleted if I do a gut test. 35:29 That allows for bad bacteria like bacteria related to small intestinal bacterial overgrowth or yeast, specifically candida, 35:39 overgrowing and in itself resulting in symptoms like depression, anxiety, brain fog. 35:48 Now, nutritionally, if the gut isn't healthy, then the child is not absorbing the vitamins and minerals. 35:58 And they're typically deficient in the B vitamins, especially B12 and folate, which, as you know, are crucial for methylation and neurotransmitter production. 36:08 Other nutrient deficiencies that I'll often see are magnesium. 36:13 that contributes to anxiety and sleep issues, but some indeed efficiency is super common and impairs immune function and mood regulation. 36:23 And then of course, you know, if kids in addition have genetic SNPs that further impair methylation and detoxification. 36:32 You've got this vicious cycle where there's toxin accumulation that further impairs gut function, driving more inflammation. 36:40 So healing the gut is essential for neuropsychiatric recovery. 36:46 We've got to restore brain health and gut health. 36:50 It's not kind of just one or the other. 36:53 Right. 36:54 So when you're treating psychiatric symptoms in children with vector-borne diseases, obviously the gut is one of the main places that you start. 37:03 Yeah. 37:03 Taking that into consideration, and you don't have to go back through everything that you just said, but how do your treatment protocols differ from that 37:12 of traditional psychiatry? 37:13 So what else were you doing to get to the root cause? 37:17 Right. 37:18 So the first thing is taking a detailed history and timeline analysis. 37:24 So we're spending a lot of time like really trying to figure out when did the symptoms start? 37:29 Then what preceded those symptoms? 37:32 Were there any geographical season patterns? 37:35 really trying to be like a medical detective and that's how I'll describe it to patients and like I'm joining with them to like really figure it out and 37:45 then they participate. 37:46 It's like exciting to kind of come to that diagnosis together. 37:52 Then I use comprehensive testing including advanced line panels not just the standard ELISA testing, which misses at least 60% of cases.
Key Takeaways for Families and Practitioners 38:03 I will follow immune function like tracking CD57 natural killer cells, which is often low in chronic tick-borne illnesses. 38:13 Sometimes I'll look at for cytokine panels showing elevated IL 1 beta or TNF alpha or IL-6, which correlates with neuroinflammation. 38:25 I'll often use organic acid testing because that can help me look at cellular metabolism and neurotransmitter production and microbial overgrowth in the gut. 38:37 I'll often look at methylation panels, including looking at B vitamins like B9 and 12 and homocysteine. 38:46 And then if you're lucky enough to go to Dr. 38:49 Eamon's clinic, you can get a SPECT scan, but most little practices don't have SPECT scans. 38:54 So in our clinic at Arbor Health, we look at quantitative QEEGs. 39:00 which can reveal specific patterns of brain dysfunction. 39:03 And so the key is pattern recognition. 39:06 We're looking for multiple abnormalities of immune function, inflammation, detoxification, neurotransmitter metabolism. 39:14 And then when we are treating it, we're peeling back layers of that onion. 39:22 It's not just treating the primary infection. 39:25 We're really having to kind of Address all of those layers to get a true healing like I am so pleased when parents will tell me my kid was exposed to name 39:38 it strap micro plasma and They got a fever which is great because now the immune system is working well Then they got over it and they didn't flare their 39:49 psychiatric symptoms. 39:50 Then you were like, yes, now the immune system is working normally. 39:56 I also use medications. 40:00 I don't throw out medications. 40:02 I use supplements. 40:03 I use medications to help with the acute psychiatric symptoms as they present themselves. 40:09 I'm also treating anxiety and depression, but it's a bridge until we get at treating the underlying root causes, it's not a means to an end. 40:22 Right. 40:22 Yeah. 40:23 And it's important quality of life, right? 40:25 We need to make sure that the child is experiencing and the family is experiencing quality of life while this usually pretty long and intense healing journey 40:39 is underway. 40:40 And I just really feel for the parents because this stuff is hard for parents. 40:46 Often, you know, this pans, pandas hits out of the blue and parents don't know what's going on. 40:54 Parents don't know how to deal with it. 40:57 They're often blamed. 40:59 They're often invalidated when they go to their doc's office. 41:03 They're Docs often don't know how to treat this and the journey for parents can be very, very difficult. 41:13 And so parents need a lot of validation and support and help to get through this from a psychiatric perspective, a behavioral perspective, 41:23 as well as treating the actual infections. 41:26 Yeah. 41:27 So what are the most important messages you want families and practitioners to take away about the biological basis of mental health issues and kids and 41:37 where we're failing them? 41:38 I think the most important message is that sudden onset psychiatric symptoms in previously healthy children should trigger an infectious disease workout, 41:49 not just a psychiatric evaluation, mental, illnesses do not appear overnight, but autoimmune encephalitis from infection does. 42:00 And unfortunately, psychiatry is one of the few specialties that we don't routinely run physiological tests or evaluate the primary organ, 42:07 which is the brain. 42:09 So, you know, we're failing these children by just accepting the psychiatric labels without investigating the root causes. 42:17 So when a child like a 10 year old suddenly develops severe OCD literally overnight, that's not a psychiatric illness. 42:24 That's a medical illness affecting the brain. 42:27 So that child needs a medical workup. 42:29 not just a psychiatric evaluation. 42:32 And parents need to trust their instincts. 42:35 Parents know their kids better than anyone. 42:37 So if they've fundamentally changed after an illness or a camping trip or moved to a new area, push for infection testing, 42:48 regardless of what the first practitioner that they see says. 42:52 And then for practitioners, that paradigm shift needs to happen. 42:57 So start thinking of the brain as an organ that can become infected, that can become inflamed, not just a site of chemical imbalances. 43:07 Psychiatric symptoms can be medical symptoms, especially in children. 43:12 And then I want to offer hope is that so many of these children's are completely treatable. 43:17 if we just address the underlying infection or inflammation. 43:21 So instead of us putting them on lifelong psychiatric medications for conditions that can be cured, we need to be looking for the underlying root cause 43:32 and addressing that. 43:33 So the future of pediatric functional psychiatry or adult functional psychiatry must include infectious disease evaluation. 43:43 And I offer hope because these infections can be treated and psychiatric symptoms can be resolved. 43:55 I couldn't have said it better. 43:57 So thank you. 43:58 Thank you so much for being here with all of us. 44:01 Thank you so much for the opportunity to talk about this. 44:03 As you can probably hear, this is a passion and I want more people to know about this. 44:09 Yes. 44:10 And I'm so excited to listen to your lecture at the Lime Bytes Symposium. 44:14 So Dr. 44:15 Zendi, what is your favorite part of the Lime Bytes Symposium? 44:19 This is going to be your second year speaking. 44:22 I love getting together with other practitioners. 44:25 There's such a synergy and an energy of actually being in person with other practitioners, solving this medical mystery together. 44:36 So that is always invigorating for me. 44:40 Wonderful. 44:41 Thank you. 44:42 So for those of you listening, if you want to hear Dr. 44:46 Zendi's formal presentation on all of this, everything that we've talked about and more, tune into the Lime Bites Symposium November 14th and 15th. 44:58 You can come in person. 45:00 It's at the Pompano Beach Marriott in Fort Lauderdale, Florida. 45:04 Or you can join us virtually from anywhere. 45:07 So again, I'm so excited to hear your actual lecture on all of this. 45:13 Thank you so much, Mariah. 45:14 I really appreciate it. 45:16 Absolutely. 45:17 And thank you all for listening to the Lime Bites podcast. 45:21 I hope this brought you one step closer to true healing. 45:24 And if it helps you share it with someone who needs to hear this too, because together we all heal stronger. 45:32 Take care. 45:32 Thank you for tuning in to Doctor Talks. 45:34 We hope today's episode has enlightened and inspired you on your path to optimal health. 45:39 Each day is a new opportunity to make choices that empower your wellbeing. 45:44 For more insights and strategies, subscribe to our podcast and visit our website, www.doctortalks.com. 45:53 Stay connected, stay healthy, and join us next time on Doctor Talks. 45:58 Talks from real doctors on the issues that matter to you most.
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