MASTERING FOOD ALLERGIES

Vol X No. 1                                                                      January - February 1995

Yeast-Related Mental Disturbances

Psychiatric symptoms elicited through biological (physical) mechanisms

An interview with Richard G Jaeckle MD

RJ: To answer that, let me tell you about how I stumbled upon this concept.  My observations started with a twelve year old patient, a girl who had been seen by many different kids of physicians, without any - or much - help.

AK was referred to me as a last resort because she was becoming increasingly unruly - her family, teachers, and pediatric hospital units were no longer about to handle her.  She was, in fact, frankly psychotic at times.  We tried her first in an environmental unit, but she couldn't be handled there - and the parents became very disenchanted with that approach and wanted to take her home despite her illness.  Nevertheless, in that brief hospitalization we were able to determine that her problem was due to aggravated food allergies.

While hospitalized, we gave AK a large does of Milk of Magnesia.  It not only cleared her gut - it cleared her symptoms for about twenty-four hours.  That improvement, brief though it was, was the important clue that caused us to focus more on her intestinal tract.  At this point she tolerated no foods at all, not even rotated single-food meals, without becoming psychotic again.  Interestingly, potent antipsychotic drugs just didn't help this patient.

AK was next hospitalized on a pediatric unit, where we could continue evaluating her.  She Ate only monorotated foods.  After initially refusing to take gastrocrom, a medication that would reduce her reactivity by blocking the release of histamine, she finally started to take it.  This enabled her to tolerate a more normal diet.  Her favorable response again confirmed that she had gastrointestinal allergies.  This was our second major confirmation that we were dealing with extreme food allergies.

After discharge, we saw AK in the office for provocative neutralization of hr food and titration of inhalant allergies.  With most of her major allergens treated, we were puzzled to see no further improvement.

We had only a few antigens left to test this patient for, so her mother brought her in one Saturday morning (when I had only one allergy technician in the office, besides myself) to finish her testing. We applied, separately, the body yeasts Tricophyton, Monilia and Epidermophyton (a mixture of these is commonly knows as "TOE"

We started with a #6 dilution, no reaction.  We moved on to the 5, 4, and 3 dilutions - all with no perceptible skin or behavioral reaction.  A minutes after the #2 dilution was applied AK had a psychotic reaction that took all three of us to hold her down to prevent biting,  hitting and totally uncontrolled behavior.  

We were able to stop this reaction only after two injections of benedryl.  She quickly became completely normal and controlled again.  An hour later she was able to walk out of the office, as if nothing had happened.

With all of this, her skin exhibited only the slightest response on the #2 dilution that day.  However, the skin reactions were so minimal they wouldn't qualify as a positive wheal at the site of the #2 (the strongest dilution) injection. Over the next 4 weeks she continued to experience delayed reactions on her arm to the various dilutions.

MJ: Was she neutralized for T-E during those four weeks?

RJ: Well, we gave her what we thought were correct treatment does of T-E, which was not really neutralization.  Her behavior was fairly controlled with daily shots of the T-E mixture.   Later, when we provoked this reaction again with skin testing, she could not be neutralized at all.  This suggested that what we had been doing was not a neutralization.  Indeed, that's the history various physicians have found - once you provoke a reaction to T-E you can't neutralize it again.

At any rate, we determined that this patient's delayed reactions to T-E lasted for four weeks.  We consulted many experts and combed the literature, but found no consensus among physicians about how to treat such reactions.  Imperfect though it was, our treatment with T-E injections brought AK her first total relief of symptoms, so we knew we were on the right track.

We didn't know how long it would last, so we continued seeing her weekly for quite a while.  As the weeks turned into months with no further psychosis, it became clear that her mental symptom had been a result solely of her sensitivity to T-E yeasts.  As long as they were being treated she behaved normally.  After several months of this we decided to repeat her platelet neurotransmitter levels, a test which accurately reflects brain activity.  We were stunned to find that they had completely normalized, with increases of from five to forty fold - the forty-fold increase being in dopamine.  

MJ: That certainly sound impressive.  Is that much change common?

RJ: Oh, no.  It's very difficult to get those neurotransmitter levels to change significantly - especially dopamine.  In the past we had tried to influence them through therapeutic trails of vitamins and minerals, amino acids, medications - all with no success.  We had simply never seen anything significantly affect them before.  With such dramatic changes in this patient's values, corroborated by her relief of symptoms, we knew we were on to something important. 

MJ: Candida albicans was not a part of this patient's treatment?

RJ: No, her skin test for the monilia mixture, which contains Candida, was negligible both in the office and delayed.  Since it didn't play a significant role in causing her symptoms, we elected to leave it out altogether. 

This patient had been on Nystatin and all of the typical Candida treatment all along with no apparent relief of symptoms, so after several weeks of being stable, we decided to stop Nystatin.  In the next two weeks she very gradually declined and began to exhibit some early warning signs that she was slipping back into her psychosis.  We restarted Nystatin and she immediately normalized.

So while the usual antifungal program hadn't relieved her symptoms, they turned out to be necessary to her well-being.  The Nystatin didn't seem to be doing anything for her by itself - until we added the T-E treatment.  But by stopping the Nystatin and having her start to regress, it became clear that the infections alone weren't enough either.  When maintained on both, this young lady behaved very normally.

MJ: It sounds like those two medications really fixed her right up.  Did you do anthing else?

RJ: Besides finding the appropriate combination of medications, we always support our patients with our usual Candida protocol:

• Lactobacillus acidophilus - A very important component for recovery that we fell played a beneficial role in this patient, too.
• Diet - We suggest a no sugar, perhaps even a low carbohydrate diet.
• Vitamin C - our patients use 1000mg four times a day.
• Magnesium citrate - We instruct our patients to take enough to provoke two to three bowel movements a day.  We feel this is important because it reduces the time yeast have to multiply and it helps move the dead yeast out of the body in the stools.  So frequent soft bowel movements are critical.

As important as all of these things are, we've found that using only one or two of them just doesn't do the trick - or even using all of the supportive measure alone, without the proper dose of medications, won't work either in severely ill patients.  They almost always require "all of the above" - everything we've been talking about - simultaneously.

MJ:  You're saying that all of those factors, used together, helped this young girl recover her sanity?

RJ: Yes, they all played a role.  In AK's case getting her on antigens was the critical factor, and finding the correct treatment dose for those antigens for someone with such extremely delayed reactions was the step that made all the difference in the world.  After that, if you remember, is when she became more stable mentally.  Then she was able to cooperate, and managing her case became a matter of fine-tuning all of those factors to the most beneficial levels for this individual patient.

MJ: What broad applications for the treatment of other patients do you extrapolate from your observations of this patient?

RJ: This is a question I've pondered a lot since all of this happened.  A few weeks later I readmitted another patient for the fourth time.  Her diagnosis was schizophrenia.  It was usual and customary for the resident in internal medicine to do the admitting physical, but this time I opted to examine this patient for myself. I found - and learned for the first time - that she had extensive dermatomycosis of her lower legs and nails.  The nails were so severely affected they were discovered with infection and thickened like hooves.

Needless to say, I began to wonder if this lady's yeast infection might be responsible for her psychosis.  After her discharge from the psych unit we were able to test her for yeast and other sensitivities.  When we treated these she improved significantly.  This lady had been on all of the major psychiatric medications in an attempt to control her psychosis - an with all of that, we were not controlling it.  With the addition of antifungals and antigen vaccine we achieved much better results.

However, there were problems.  This patient lived some distance away, and her husband couldn't or wouldn't bring her in often enough for us to do as much for her as we might have.  The impatience of her husband when she had a relapse ultimately led him to have her committed to a state hospital, so was lost to follow-up.  But before that happened we were able to document that her neurotransmitter levels, which had previously been dropping (indicating a downhill course in her illness) had started up after we added the vaccine to her treatment.  WE feel if we had been given more time with this lady we might have been able to achieve a different outcome.

When yeast infections involve the toenails it can take a long period of time to eliminate them - a minimum of six months of the proper anti-fungal medication. Further, we had to grind the toenails down and debride them, and await the growth of healthy tissue.  The skin of her legs had improved significantly with the short course of treatment we could offer, reinforcing our feeling that we were on the right track.  It's unfortunate, but we just didn't have enough time with her.

We treated another lady, a more typical environmental patient.  She had lived in her formaldehyde-free trailer for twelve years.  Her husband felt he was also a prisoner of his wife's treatment, but that was the only way she could survive with her multiple sensitivities.  She was admitted to a hospital because of extensive hemorrhage-like lesions in her skin.  I forget exactly what her dermatologic diagnosis was, but I was consulted because she was also psychotic.  I wrote an extensive note on her chart expressing the opinion that this was a yeast problem.

The patient wasn't rational and wouldn't cooperate with either testing or treatment.  I don't think her internal medicine physician had a chance to do anything about the yeast infection because she very soon had to be transferred to a psychiatric unit.  As soon as she was moved we immediately started Nystatin, along with appropriate psychiatric medication to stabilize her.  The skin lesions started to fade almost at once, and within a week had almost completely disappeared.  Her white blood count, uric acid and CPK enzymes were all elevated, and all returned to normal after just a few days on Nystatin alone.

This was the third time I had seen those three elevated values occur together in similar cases - psychotic patients with overriding yeast overgrowth infections.  In fact, I've come to view those lab results as a diagnostic triad of markers for such patients (Jaeckle's Triad). With proper antifungal treatment we can quickly turn this around, those values return to normal, and the patient becomes much better in just three or four days.  It's quite amazing.

MJ:  Are you saying that elevated white blood count, uric acid and CPK enzymes in the lab work suggest a diagnosis of a yeast-induced psychosis?

RJ: Yes, I believe that is true.  But not all patients with yeast problems have an overgrowth of such massive proportions, to be reflected in the lab work.  In other words, that is true when it occurs, but not exhibiting those elevations does not rule out yeast involvement.  Patients may experience toxicity from the toxins generated by yeast, they may have an allergic reaction to the yeast itself or to the yeasts' toxins, or probably other mechanisms, too.

Every possible way yeasts may make patients ill is more than we can go into just now.  But I can refer interested readers to a very complete and balanced discussion of this in Jonathon Brostoff's book Food Allergy.

MJ: Can we finish the story of the EI patient?  We sort of left her hanging.

RJ: Of course.  She improved rapidly with antifungal treatment.  In the hospital setting we were unable to do the skin tests so we could add the specific antigen vaccine. She improved on just the Nystatin, low does of psychotropic medications, and some vitamins and minerals.  Her skin cleared, her psychosis cleared, and we were able to discharge her in about two weeks.

She returned to the office for follow-up testing a week after discharge.  We determine her end points for various yeasts, so were able to get her protected that way, too.  She and her husband both felt like they had been let out of prison - they ate out in a restaurant and visited a shopping mall for the first time in twelve years - all without any adverse reactions.

Yeast treatment alone literally turned around this EI patient who through she had numerous chemical sensitivities - and she did, we're not disputing that.  But when we eliminated the yeast problem, and also the depression which as secondary to the yeast toxins, then she had no chemical sensitivities!

MJ: What about her craziness?  could she discontinue the psychiatric drugs?

RJ: Not quite.  She's on very low doses of elavil and lithium, and as she continues to behave in a stable manner we will decrease them further until they can probably be phased out altogether.

It's not uncommon to see EI patients who are clinically depressed, confirmed by testes of their neurotransmitters.  Some, after their depression was treated, have wondered if they had really had chemical sensitivities at all.  Of course they did.  But what that means is that their depression was aggravating their chemical problems, either making them worse or making them seem worse.  When the depression was treated they started to feel better.  As that happened they seemed to develop new reservoirs of well-being, a new resiliency in which environmental factors didn't bother them to the degree they did previously.

If we are able to identify a population of patients who have depression due to yeast toxins (confirmed by changes in their neurotransmitters) - then we will truly have established an environ-mental cause of depression. Further confirmation of the cause-and-effect link would be seen when the depression - and effect link would be seen when the depression - and psychosis, in severe situations - lifted in response to antifungal therapy, as we've seen in our patients.

Some patients may have mild enough yeast involvement that when only their psychiatric disorder is treated they are able to respond and more or less normalize.  But every psychiatrist has probably treated patients who schizophrenia, psychosis, and/or depression just wouldn't respond no matter how many potent psychotropic drugs they tried.  This is the patient population I think we're finally able to help: I'm suggesting that we achieve mood improvement, improved self-control when necessary, and so on, by vigorously and aggressively addressing those patient's yeast infections.

MJ: Were you an early "convert" to associating yeast infections with psychiatric symptoms?

RJ:  No, absolutely not.  Of course we had heard about Candida yeast infections over the years.  Some of that information, however, seemed blown out of proportion, almost implying that all other medical diagnoses were obsolete, and there was only one diagnosis valid for all physical complaints.  Such wild claims turned many of us off.  I, personally, didn't really give Candidiasis much credence until that episode with the twelve year old girl.  yeast as causative agent for psychosis was absolutely inescapable in that case.

The more I work in this area the more I learn that we are, indeed, talking about a human body.  I've never seen a personality without a body.  So we're making distinctions that exist only in our minds when we try to separate them.  When I make a psychiatric diagnosis and start treatment, I'm still treating a body.  Viewed in a context of the whole person, it's not surprising that we should find psychiatric symptoms being elicited through biological mechanisms.

MJ: In view of what you're saying, allow me to pose a hypothetical situation.  If you were to visit a psychiatric unit of twenty patients, how many do you think would have physical problems that were not being addressed?

RJ: Virtually all of them.  I base my answer on my experiences, since that first case caused me to see yeast as a causative factor.  Now I do my own physicals on new patients, spend more time with them, and ask more and different questions.  Since I've been doing this I've never failed to find some physical manifestations of ill health.

In the past, psychiatrists in general weren't catching many physical ailments because they didn't consider them pertinent or related to the problem at hand.  Physicials for a psych admission were often cursory, at best.  We can summarize with this "If you don't look you don't find."  

Learning to evaluate allergies and nutritional status - just those two areas of physical assessment - have increased the tools I have to work with, and have increased the help I'm able to give patients. And the patients receive less toxic and more wholesome treatment now - more curative, if you will.

Mastering Food Allergies.  Published 6 times a year.