Treating mental health in the pediatric age range. Moving beyond drugs to a more holistic approach
An Interview with Dr. Pejman Katiraei
It takes someone special to become a pediatrician… And taking care of kids with problems like anxiety, depression and ADHD is another league.
Before we get into the medical stuff, I’d like for my audience to learn a little bit about you. What was your personal journey like, and how did you home in on caring for kids with behavioral issues?
PK:
I had always dreamed of going into medicine – that is until I got there. To say the least, I did not enjoy medical school. The medicine I was learning did not make sense to me, to the point where I entertained leaving medicine altogether. That was until I did my first pediatrics rotation. Within days it was clear that I had found my future career path. Children are magical to me. Seeing children smile and thrive is one of the things that give my life meaning (my children and wife, family and friends being others).
My childhood was not easy. We left Iran in the middle of the revolution, and for 2 years my dad was not with us. At times, we could not communicate with him for 3-6 months because he was in prison in Iran for trying to escape illegally. Some nights I would go to sleep wondering if I would ever see my dad again. There were other traumas as well. Beyond these traumas were the physical imbalances that took over a decade for me to figure out.
When I was younger, I experienced severe focus problems, high anxiety, bouts of depression, etc. I recall moments in my adolescence where I would cross a street hoping I would get hit by a car because I imagined that pain was less than what I felt at the time. I knew there was some explanation for why I experienced the world as I did – and it was clear that my experience was different than most other people.
There was one other factor that ultimately pushed me to look outside of conventional medicine. During my pediatric training and residency, I had several cases that made absolutely no sense medically. An amazing young man was playing soccer and got a small scratch on his knee. 8 hours later his knee was swollen and 24 hours later he died because the bacteria had spread from his knee to his entire body. Somehow the other physicians thought this was just expected and normal. What was it about his body that allowed this awful thing to occur?
I had another dear teenage boy with severe colitis. He had failed all pharmaceutical treatments and had a colon so inflamed that had ballooned out (megacolon). The team had a meeting and unanimously agreed that the logical next option was to cut out this young man’s entire colon. What about his diet, probiotics, nutrients – or any other option? The team immediately discounted the possibility. It was strange to me how willing we were to sentence this young man to a lifetime of digestive challenges without a colon, but we could not even take a moment to consider there were options outside of what we knew.
These collective experiences had me realize there must be more, and that is when I started my journey into holistic or integrative medicine in 2008. This journey was to find more answers and to better understand why seemingly unexplainable health problems occur.
Over the next decade, I came to understand how various digestive, immunological, hormonal and epigenetic imbalances were significantly contributing to my mental health issues. Interestingly enough, it turns out that I have a physiology that is very similar to most of the children I serve. The more I learned how to heal myself, the more I learned how to heal these children – AND vice-a-versa. These children and their families have also taught me a tremendous amount.
The challenges these children face – extreme anxiety, suicidal depression, destructive bouts of aggression, concerning levels of oppositional behaviors, etc. – all have a reason for being there, and often it goes beyond the psychological. I love working with these children because I have seen some children literally transform into a loving, kind, happy and balanced person within 1-2 months once the key areas of physiological imbalance are addressed and their health and vitality is restored. There is no way to put into words the joy and gift one feels to witness this transformation. This is why I do what I do.
Please explain how environmental toxins, like mold, might factor into causing different behavioral issues?
PK:
To understand how these toxins impact behaviors, we must first understand what physiological pillars these toxins disrupt, and how these pillars impact the human mind. I had the pleasure to do a fellowship in a French model of systems biology (Endobiogeny). Systems biology is the study of how all things in the body are interconnected. Every system can impact every other system. The basic sciences have demonstrated these connections, but very few have put this scientific data into practice.
Take for example mold. There is a strong body of published literature that tells us that mold toxins can disrupt:
1) Mitochondrial function
2) Microbiome and mycobiome (fungal balance)
3) Gastrointestinal tract (resulting in leaky gut, inflammation and bacterial translocation)
4) Antioxidant production and detoxification pathways
5) Hormone production
6) Neurons and activate the microglia (immune cells within the brain), etc.
7) And much more
Now imagine a child who is exposed to significant amounts of mold toxins for several years. This becomes even more concerning if that child is exposed in the first formative years of life when multiple body systems are developing (microbiome, neuronal pruning/plasticity, immune priming/tolerance formation). There are some physicians who worry that this early exposure may be one explanation for why some children develop autism.
How does this all come together? As in the diagram above, imagine if two or three key pillars of health/physiology start becoming weak or imbalanced. They then set off a domino effect which starts causing subtle or significant imbalances in other systems, and this collective impact then causes rather unusual manifestations within the nervous system (anxiety, OCD, depression, learning problems, etc.).
It is important to highlight that this conversation extends well beyond just one toxin. Studies tell us that all human beings (newborns included) have some exposure to countless toxins (pesticides, plastics, etc.). Our best understanding is that this unavoidable exposure creates some vulnerability within the body, and then the prolonged mold toxin exposure (as one example) is what tips things over.
Now some people may ask – well how is it that these imbalances actually cause the mental health issues? Here are some examples:
1) A cascade of events ultimately leads to over activation of a specific line of immune cells called mast cells. These overactive mast cells produce excess histamine. It turns out this excess histamine can result in anxiety, changes in appetite, strange sensory findings (places are too loud, clothing too scratchy..). When you closely look at what many children with anxiety or oppositional defiant disorders face (a large % have unexplained sensory issues…) you find how well a simple compound like histamine can explain the seemingly unexplainable. https://pubmed.ncbi.nlm.nih.gov/18626069/
2) Gastrointestinal imbalances often cause immune imbalances, and over time these immune imbalances can cause swelling of the adenoids and tonsils. If the adenoids and tonsils get large enough, they cause airway obstruction during sleep. Studies have demonstrated that obstructive sleep apnea can result in a host of mental health problems.
3) A series of events leads to a subtle disruption in the mitochondria and energy production (ATP). In a region of the brain called the prefrontal cortex, we have these cells called GABAergic interneurons. These brain cells are like the traffic control cops of the brain and are responsible for controlling the flow of information (especially from the senses) through the brain. It turns out that these specific brain cells are highly sensitive to even slight disruptions in energy production. It is almost as if the traffic control cops of the brain develop chronic fatigue and are too tired to do their job, and so you develop a traffic (information) logjam within the brain. This logjam happens to feel like anxiety, because there is just too much, uncontrolled information at one time.
The list of examples can go on and on. Through a systems biology lens we are able to understand a lot more about these children and the challenges they face. More importantly, understanding the physiological underpinnings gives us a roadmap of what we can do to help these children.
About 40 trillion bacteria are living inside your body right now (called the microbiome). Most of them reside in your gut and don’t cause any health problems. Besides those little bugs, you are composed of roughly 30 trillion human cells. So, human cells are outnumbered in our own bodies. All those bacteria may have effects on your brain through the Brain-Gut Axis. How does this play into causing different behavioral issues?
PK:
The more we learn, the more we realize that these trillions of bacteria influence just about every part of our daily experience of life. These bacteria influence levels of brain chemicals (serotonin, etc.). These bacteria can influence mast cell activity, which as noted above can influence histamine levels and a host of cognitive experiences. Since these bacteria also regulate the entire body’s immune system, they influence immune activity within the brain. Vitamins, including B vitamins, are important cofactors for countless enzymes that regulate brain chemicals. These bacteria either directly produce these vitamins or significantly impact our ability to absorb these critical nutrients. If that was not enough, it turns out these bacteria are in direct communication with our nervous system and can even influence the activity of our parasympathetic nervous system (rest and relaxation).
To say the least, when the microbiome is out of balance, there is a high likelihood that the nervous system will also be out of balance.
In addition to (or in lieu of) the commonly prescribed medications, what type of holistic treatments have you found to be most beneficial for pediatric patients with behavioral issues?
PK:
There is no “most beneficial” treatment for a given behavioral issue. A treatment that works perfectly well for one child with anxiety or ADHD can completely fail in another child. This is why we see such a discrepancy in much of the published literature that attempts to explore the role of vitamins or other treatments in given mental health challenges.
We must understand that every child is completely unique, and so are the reasons behind the challenges they experience. One child may have a mitochondrial imbalance behind their ADHD or anxiety. Another child can have imbalances in the microbiome, and yet another child toxicity due to mold exposure.
To really make a difference, we must start by asking, what are the specific imbalances that are causing THIS child to struggle, and what were the key factors that started these imbalances. Based on this understanding, then we can select the most beneficial treatments for that child (B vitamins, CoQ10, probiotics, surgery to remove tonsils, etc.).
Besides research and a busy clinical practice, you’ve developed a fascinating social media presence. Where can my audience connect with you?
PK:
Please feel free to follow me at wholistickids@instagram
What would be the best way for the parents of a patient to contact you?
PK:
My private practice is mostly closed to new patients. I am focusing the bulk of my time and energy to build a new platform that allows families anywhere the ability to access this detailed understanding of their child and the factors that may be impacting their ability to learn or regulate their emotions. This platform is called Wholistic Minds.
