PRIMAL CPC 1: TOURETTE SYNDROME MEETS EVOLUTIONARY MEDICINE

PRIMAL CPC 1: TOURETTE SYNDROME MEETS EVOLUTIONARY MEDICINE

image_printPrint PDF

READERS SUMMARY:

1. WHAT IS TOURETTE’S SYNDROME?

2. HOW MIGHT IT BE LINKED TO A LEAKY GUT, GRAINS, AND TIE TO OTHER DISEASE’S WE KNOW NADA ABOUT?

3. HOW DOES OUR HARDWIRING GIVE US NEW INSIGHTS?

4. HOW MIGHT NEUROSURGERY HELP CHRIS JOHNSON?

5. HOW MIGHT SOME PIONEERING DENTISTS TIED A NICE BOW ON THERAPY FOR CHRONIC TS PATIENTS?

 

Tourette’s syndrome (TS) is defined as an inherited neurological disorder that is a chronic idiopathic syndrome that neurosurgeons consider in the family of movement disorders. Today’s blog is called a CPC. That is known as a clinico-pathologic conference for my readers. Every so often I am going to post about a disease process and how evolutionary medicine may look at something that modern medicine is vexed by. We neurosurgeons generally do not treat these patients but neurologist however do.  In my town of Nashville,  we have a very famous running back, Chris Johnson,  who is a superstar that has a variant of this condition.  The disease is characterized by the presence of multiple muscle tics and occasionally vocal tics that have their beginning before adulthood.  It usually occurs with an onset in childhood between ages 5-8.  A diagnosis of TS was almost three times as likely for boys as girls, twice as likely for persons aged 12–17 years than for those aged 6–11 years, and twice as likely for non-Hispanic white persons than for Hispanic and non-Hispanic black persons. Among persons ever diagnosed with TS, 79{a7b724a0454d92c70890dedf5ec22a026af4df067c7b55aa6009b4d34d5da3c6} also had been diagnosed with at least one co-occurring mental health or neurodevelopmental condition. I think the reasons for males is because they generally have larger area postrema in their fourth venticles of their brains than females allowing for more antibodies to pass into the CSF. This is a time where most brain growth is beginning to slow in the brainstem while the immune system is also becoming more mature.  This implies that before these ages the developing brain and immune system are not ideally protected from inflammation, toxin, or antibodies.  Modern medicine has no answer for the causes of this disease.  I think evolutionary medicine might have an answer for some of the patients who suffer from it if they would just think about their disease from a new perspective.  I think this syndrome and other movement disorders might be caused by a leaky gut due to gliadin antibodies that bind to synapsin on developing nerves and cause a short circuiting in the brain stem wiring that allows for nerve depolarization (action potential) to jump onto other damaged nerves that are close located to one another in the brainstem.  I have long thought about these conditions as a neurosurgeon because I think the key insight is the wiring proximity in the brain stem that most in my profession have not realized are closely related.  I think the key insight is that we now know that the gliadin protein has been modified over the last 50 years by man and the incidence of celiac disease in that same time frame has increase from 1{a7b724a0454d92c70890dedf5ec22a026af4df067c7b55aa6009b4d34d5da3c6} to 5{a7b724a0454d92c70890dedf5ec22a026af4df067c7b55aa6009b4d34d5da3c6} of the population now.  The prevalence of Celiac Disease has increased five-fold overall since 1974. This increase was not due to increased sensitivity of testing either,but rather due to an increasing number of subjects that lost the immunological tolerance to gluten in their adulthood. The proof is right here: Ann Med. 2010 Oct;42(7):530-8. It may  also may surprise you is that functional movement disorders also have increased during the same time period.

Conventional medicine knows that gliadin antibodies cause a rare devasting syndrome called either idiopathic or sporadic cerebellar ataxia.  This syndrome actually causes permanent ataxia because it causes destruction of the major nerves in the cerebellar hemispheres that coordinate our motor movements.  It is a fully known and recognized cause of a movement disorder.  Today it is one of the few movement disorders that conventional medicine has linked to gluten/gliadin antibodies.  Even fewer people realize that Autism and other spectrum disorders all begin by altering hindbrain development in humans.  Autism being the best known and essential tremor being the most common but rarely linked functional disorder of the cerebellum and thalamus.

Well today I am going to walk you down a path of maybe why TS maybe another disease that could be related to grain use too.  The story will require you to learn some pretty complex neurosurgical wiring in the brainstem but I think the connections we make in this blog will help you really understand why the brain/gut axis is the fifth levee in my Quilt.  A leaky gut can cause tremendous problems for our species whether conventional medicine believes it exists or not.  The treatment I think is also too easy not to try…….just eat a paleolithic diet as outlined in the Paleo 1.0 diet books.  I do think that this diet has to be started as soon as symptoms show up in children because the disease maybe reversible then.  I think if the symptoms stay with the child they become hardwired into the brainstem because the shortcircuits act just as any neuron in the CNS.  Neurons that fire together wire together.  This is called Hebbian learning and any neuroscientists knows that this is how our brains are designed to work by evolution.

 

Associated diseases with Tourette Syndrome:

 

TS patients will sometimes exhibit co-morbid conditions that may occur with their symptoms. Some patients have shown the following associated conditions:

 

A. Attention Deficit Hyperactive Disorder (ADHD) The link is inflammation from the gut in my opinion.

B. Obsessive Compulsive Disorder (OCD) The link again is the leaky gut.

C. Sleep Disorder due to alterations in leptin and metabolic coupling

D. Increased Enuresis in children due to ADH release issues at the blood brain barrier

E. Bipolar Disorder Again we have another leaky gut link I believe.

 

Not all TS patients have these associated diseases, and it is not a certainty or requirement that these conditions exist with this disorder. The majority of TS patients have only the movement disorder without any other associated disorders. The CDC says otherwise in the 9th cite but that does not follow my clinical sensibilities.

 

Many pediatricians today know that there is a hypothesis out there that TS might because by streptococcal infections of early childhood in a syndrome known as PANDAS.  In the April 2004 issue of Pediatrics, researchers Kurlan and Kaplan reviewed current scientific information and concluded “that PANDAS remains a yet unproven hypothesis.”  TS and PANDAS provided me about 7 years to think about how this disease might happen from another mechanism.  That mechanism that might cause this is gliadin antibodies that attack the brainstem wiring in the developing nervous system of children by entering the brain via the area postrema. The gliadin antibodies seem to bond irreversibly to a protein in the developing nervous system called synapsin. The area postrema is a circumventricular organ that is the seat of the vagus nerve. Damage to the area postrema can result in a syndrome called a central vagotomy. This is when the vagus nerve becomes completely disconnected to the gut. This is a huge link in eating disorder progression that I will be covering in the future. The area postrema is how the brain connects directly to the entire gut from the tips of your lips to the transverse mesocolon.  The vagus nerve wiring is a critical link in understanding how this disease might be caused by gliadin antibodies.

Most of the motor tics in TS are linked to the head and neck.  This is controlled by another cranial nerve called the trigeminal nerve.  It has three divisions, called the opthalmic, maxillary, and the mandibular divisions. These fibers run very close to the fibers of the vagus nerve in the brainstem.  I believe the source of TS is cross talk between these two cranial nerves due to damaged caused by gliadin and gluten antibodies.  This is called ephaptic transmission.  This type of abnormal wiring is known to happen in many biologic systems.  In my 6th cite you can read about how it occurs in primates who are closely related to us.  These findings suggest that nerve fibers of different types communicate with each other.  This is especially true when sensory or motor neuron cells degenerate for any reason.  The surviving neurons which have lost their connections to these nerve cells, may still send electrical signals to the many brainstem nuclei through the synapses and ephapses of their neurites in the brainstem to cause the tic’s that are classically associated with TS. I am going to hurt your head now…….with some deep seated neurosurgical anatomy to show the biologic plausibility of what I am proposing to you here in this blog.

 

THE WIRING DIAGRAM:  You might need a neuroanatomy book to really get this down after you read it 1000 times.

 

Frequently one of the first clinical signs of TS is repetitive and uncontrollable eye blinking. If the pathway for the blink reflex is examined, we notice that CN V transmits tactile sensation from the cornea, which is perceived as irritation that evokes bilateral eyelid closure (an eye blink). Trigeminal opthalmic primary afferents send signals which end in the spinal trigeminal nucleus (subnucleus caudalis). From here, interneurons connect to the reticular formation. Within the reticular formation, interneurons send signals to the facial nucleus, cranial nerve VII. Facial nerve efferent neurons from the facial nucleus send their signal to the orbicularis oculi which closes the eyelid; blinking occurs. This is the simplified version of the corneal blink reflex neural circuit.

I believe the primary incoming afferent signals can come from other sensory branches of the trigeminal nerve itself. This is what may cause the reflex arc to occur. Very frequently and often unobserved, low order but constant nociceptive impulses transmitted by the auriculotemporal nerve, with its vast number of sympathetic fibers, come into the trigeminal ganglion and using the above described afferent neural pathway, and end in the subnucleus caudalis through ephaptic transmissons.  The cross talk is allowed to occur because of gliadin/gluten autoantibodies that cause myelinolysis and axonal electrical damage by binding to synapsin on the nerve.  This affects aquaporin 4 function on the neuron cell membrane.  This is now being studied today by Dr. Peter Green of Columbia University in NYC.  He has written a book about gluten/gliaden related diseases and ironically I spoke to him yesterday on Doctor Radio on Sirius XM radio.  Here is a link to his excellent book.

Motor efferent nerves from this nucleus may stimulate other muscles of facial expression such as frontalis, orbicularis oris, platysma, and zygomaticus major and minor, etc. These are some of the muscle groups which are implicated in facial motor tics. I believe that it is the afferent sensory fibers in the mandibular division of CN V that are causing oro-mandibular dyskinesia to be manifested into and through CN VII.

Another frequent finding in TS is throat clearing and sniffing. Examining the anatomy of the trigeminal nerve, one can see that within the spinal tract of V, which ends in the subnucleus caudalis, there are connections within the subnucleus caudalis to the glossopharyngeal nerve, CN IX, which contains general sensory fibers and provides sensation from the posterior 1/3 of the tongue, tonsil, skin of the external ear, internal surface of the tympanic membrane, and the pharynx. When this nerve is chronically stimulated, the cough/gag reflex becomes stimulated. If the primary chronic stimulus was not from CN IX, but was from chronic ephaptic stimulation within the subnucleus caudalis where CN IX and CN V decussate, would not the cough/gag reflex be stimulated possibly?  I think this is precisely what happens in TS.  I have not seen one neurological or neurosurgical discussion that can explain this phenomena as perfectly as this one does.

A well-documented finding in many movement disorder patients with TS is echolalia (the spontaneous utterance of sounds). Examining the anatomy within the subnucleus caudalis, one can see that the vagus nerve, CN X decussates within the spinal trigeminal nucleus as does CN V.  It appears to me that the real cause of TS maybe the cross talk between the auriculotemporal nerve that is a branch of the trigeminal nerve with brainstem reticular formation that controls the many of the autonomic and complex reflexes that allow us to stand upright and turn our head and upper torso.  These motor tics perfectly fit TS.


 

OKAY DOC my head really hurts…….how does this tie into the LEAKY GUT?  Its gonna hurt some more………

 

The vagus nerve is also known as CN X in the neurosurgical literature. CN X is a general sensory afferent nerve providing sensation from the posterior meninges, concha (ear), and skin at the back of the ear and in the external acoustic meatus, part of the external surface of the tympanic membrane, the pharynx and the larynx (the vocal cords). As a result of its irritation, the voice feels hoarse and a clearing of the throat results. I believe that if the primary irritant was not from CN X itself but originated from CN V within the subnucleus caudalis’ ephaptic connections, the vocal expressions of echolalia (throat clearing, grunting, or barking sounds) would occur

Another documented clinical sign with those who have TS is shoulder shrugging. We know that the muscles of the neck (sternomastoid) and shoulder (trapezius) are innervated by the spinal accessory nerve, CNXI. This nerve originates at the level of C1 through C5 as rootlets from the anteriolateral portion of the anterior horn of the spinal cord. The myelinated fibers of the spinal tract of V and the large spinal nucleus of V also extend to the level of C2. The ventral horn of cranial nerve XI gives rise to the motor portion of the nerve, and it also goes to the level of C2.  Second and most importantly, the trigeminal nerve also projects primary afferent nerves to the reticular formations raphe nuclei which stimulate the medial and lateral nucleus portions of the reticular formation( nuclei in the brainstem that allows you to wake up). These areas project both rostally (superior) and caudally (inferiorly) throughout the brainstem’ s tegmentum and influences both autonomic and voluntary muscles reflexes.  According to the textbooks by Alf Brodal, The Central Nervous System (2004), and Charles Noback, The Human Nervous System (2005), the pontine medial reticular formation, when stimulated, mediates posture and orients head and neck movements and turns them to the ipsilateral side. This is why people with TS have upper body tics that go along with their facial tics. If you have not seen a person with this syndrome, google Tennessee Titans superstar RB Chris Johnson and watch his movements in interviews.  It perfectly describes these mind bending neurological wiring diagrams I am laying out here for you.  It also might help you visualize how a motor behavior could be influenced by our dietary choices.

 

WHAT MIGHT THE REAL CAUSE OF TS BE?

 

I think the a branch of the trigeminal nerve called the auriculotemporal nerve is “cross talking” with the reticular activating system in the brainstem due to gluten damage.  This is the real cause of TS looking at it from an evolutionary medical perspective. These reticular cell groups are called premotor networks and they control activity of large groups of muscles such as in the neck, trapezius, sternocleidomastoid and axial muscles of the head and neck. This is the area when stimulated by CN V, implicates the shoulder shrugging and head turning classically seen in most TS patients.

OK……..now you are beginning to understand why neurosurgery residency is so damn long.  It takes a while to learn all this complicated wiring might help explain these links that cross many disease processes. If you like this blog post you are going to love my book…….because it is filled with looking at diseases from this new perspective.  It has fueled me to cure myself of diseases and along the way it made me realize that within us the answer to many diseases has always been right under our noses if we just look at the owners manual we came with…….That is how evolutionary medicine make you a healthier patient and a lot better healer for our species.

 

NOW WHAT MIGHT WE DO TO TREAT TS PATIENTS WHO ALREADY HAVE SUSTAINED THE PERMANENT DAMAGE TO THEIR BRAINSTEM FROM THE GRAINS?

 

The first thing to do would be to eat a strict paleolithic diet that avoids all grains that contain the gluten/gliadin proteins obviously.  You might be shocked to learn……that this is a recommendation that most pediatricians and physicians do not make today because they have no clue about how TS might occur!

 

TS might just be a nutritional disorder that is easily treatable and possibly preventable if the parents/patients take action in spite of what modern medicine might tell you today.  Doing an elimination diet is not damaging to any child or adult and it might just make a huge difference in their symptoms.  I did tell you earlier, that once the cross talking of neurons is hardwired it might be hard to stop the classic tics.  My concern is that for adults eliminating the grains might lessen the other medical co-morbidities that walk hand and hand with TS we mentioned above.

There is another more interesting possible cure for the older TS patients who have bad tics.  Now I am going to draw on my previous dental education and introduce you to some dental ideas that may help people with this disorder after it becomes hardwired into their brainstems.  This comes from work of some pioneering dentists (Anthony Sims, D.D.S.; Brendan Stack, D.D.S., M.S.) who believe that if they could “unload” the tempromandibular joint with a Neuro-cranial Vertical Distractor device they could possibly stop the constant pounding of the auriculotemporal nerve that is the source of the cross talk signals that are generated in TS.  Personally, I think their idea makes a ton of neurological sense and again it requires no surgery to test this hypothesis.  All one has to do is have an oral appliance made to unload the TMJ with a vertical distractor.  I also have noticed clinically that many people with TS tend to be quiet and not very talkative.  I think this is an adaptation that most use unconsciously to limit their tics.  The more talking/eating one does the more activation of the TMJ and the auriculotemporal nerves occurs.  This actually causes more tics to be present because it allows nerve depolarization to go from the nerve that innervates the TMJ and sends the signal into the brain stem to activate complex motor arcs that are generally automatic and not spontaneous.  If you look at a TS patient you will see this in their behavior.  This mechanism completely explains how this occurs.  The fact that TS happens when the immune system and brainstem is still developing is no coincidence in my view.  It is precisely why this syndrome occurs as it does in humans who have it.  I have noticed that when Chris Johnson is interviewed here in Nashville that he suffers this same fate.  I believe he is not aware of it,  but I can say after observing him as a surgeon and fan of his for his 4 years here, I have picked up on this habit of his and it got me thinking about how this all occurs from a neurosurgical perspective.  I think the wiring diagram above displays my feelings on how this might occur.  I think gliadin antibodies are the likely trigger point for these disorders and I think everyone with a movement disorder should be screened for autoimmunity and for the newer antibodies that we know are associated with the genetic modifications of wheat that have been outlined in the literature and recently made popular by Dr. William Davis’s book called Wheat Belly.

 

The dental device holds great promise for those with long standing TS because it is so simple to fit and try.  It fits perfectly with an evolutionary medicine perspective and that is likely why medicine won’t discover it for another 100 years if they are lucky.  It is the same reason why they still have their heads in the sand with the leaky gut.

I believe when medicine discovers how a leaky gut begins and what it does to the brain it will revolutionize gastroenterology disease like Crohn’s, IBD, GERD, ALS, Guillian Barre syndrome, scleroderma, esophogeal cancer, pancreatic cancers, mental illness, movement disorders, and most autoimmune conditions.  You would think that modern medicine would look under some “new stones” to gain insights to how one might cure a disease thought to be incurable today.  Sadly, that is why dogmatic conventional wisdom creates a rut of thinking that makes the black box of these disease tighter and darker every passing year for patients with these disorders.  The brain gut axis is the source of every autoimmune disease our species faces in my humble opinion.  It is also why I think having a Leaky Gut Rx is a critical part of any physicians armamentarium to help people treat themselves at home to see if they improve by looking at their disease in a new way.  It certainly is not something that is going to harm them long term.  It is another option that just might cure them of a disease my profession has no answers for today.

 

TS is based on symptoms observed as described in the DSM and family history and ruling out secondary causes of the disorders. A PET scan, a CAT scan, and an MRI may be required to rule out brain abnormalities. Usually treatment is focused on relief of symptoms. Various medicines have been prescribed for treatment of TS. Such medicines are neuroleptics, (i.e., haloperidol) which has the only Food and Drug Administration (FDA) approval for the treatment of this disorder. Risperidone is used for tics. There are many side effects associated with these medicines. The antipsychotic medicines may cause fatigue, nausea, dystonia, Parkinsonism, deregulation of body temperature, increase in serum prolactin (hyperprolactinemia), and/or headaches. The benzodiazepines may cause or exacerbate preexisting states of confusion and hallucination or tardive dyskinesias. Also sedation, ataxia, and cognitive difficulties are associated with some of these medicines. The physician finds himself prescribing secondary medications to ameliorate the side effects of the initial medication.

One of the new treatments for TS movement disorders is the injection of the neurotoxin produced by the bacteria Clostridium botulinum, where the neurotransmitters that cause muscles to contract are inhibited. This treatment is repeated every three to four months. Patients may develop antibodies to the toxin rendering the treatment ineffective. Temporary weakness in the muscles that are being injected is usually one of the side effects that occur. Also flu-like symptoms may be evident.  I am not a big advocate of any of these conventional treatments but that is what modern medicine peddles to patients these days.

The neurosurgical answers for these diseases are even more draconian.  Remember that I am a neurosurgeon so when I tell you they are pretty dangerous and require specialized training and equipment the patient should do their due diligence and employ “caveat emptor” with those in my profession who do these surgeries.  When there is a severe movement disorder and the medicines mentioned don’t work or have become ineffective, surgery may be recommended. There are two differing types of surgery. One is called Deep Brain Stimulation (DBS) and the other is Ablative surgery. In DBS, a neurotransmitter is implanted to deliver an electrical stimulation to the area of the brain that controls bodily movement. The electrical impulse blocks the nerve signals that trigger abnormal movements. A small incision is made into the skull and an electrode is placed inside the brain extending to the area of abnormality within the brain. An insulated wire is passed through the skin of the neck, shoulder, and chest to the neurostimulator placed in the upper abdomen. These surgeries are about 75{a7b724a0454d92c70890dedf5ec22a026af4df067c7b55aa6009b4d34d5da3c6} effective in their treatment of movement disorders and may include multiple side effects. However, these surgeries have recently been questioned and have not been promoted for the treatment of TS that I know of today.

 

 

CITES:

1.  http://integrativehealthconnection.com/wp-content/uploads/2011/11/Cerebellar-ataxia-and-coeliac-disease.pdf

2.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1736152/

3.  http://brain.oxfordjournals.org/content/124/5/1013.full

4.  http://www.neurology.org/content/54/12/2346.2.extract

5.  http://www.nutramed.com/celiac/celiacbrain.htm

6.  http://www.ncbi.nlm.nih.gov/pubmed/3479885

7.  The Human Nervous System by Charles Noback and Robert Demarest, 2005 ed; Totowa, New Jersey: Humana Press.

8.  A. Sims, D.D.S.; B. Stack, D.D.S., M.S. “Tourette’s Syndrome: A Pilot Study for the Discontinuance of a Movement Disorder” THE JOURNAL OF CRANIOMANDIBULAR PRACTICE JANUARY 2009, VOL. 27, NO. 1

9. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5821a1.htm

About the Author:

60 Comments

  1. Mamagrok January 28, 2012 at 5:28 pm - Reply

    I think you are right on track with this line of thinking. Have you treated or seen anyone treat Tourette's with a grain-free diet? I have actually seen all my five year old son's verbal and physical tics retreat when I did GAPS (grain-free) with him. They return only after wheat is consumed on holidays and birthday parties. My daughter's seem to be a bit more complex, although hers are only physical, not verbal.

    I wonder how much is too much? Will *any* antigliadin antibodies, or *any* amount of occasional wheat consumption (even if just twice a year or so) cause the permanent damage?

  2. Jack January 28, 2012 at 6:01 pm - Reply

    @MamaGrok The new data coming out on just how vigorously that the gliadin antibodies bind to synapsin is pretty amazing. I think even one exposure may have long lasting effects for the afflicted. This is obviously going to evolve as we learn more about the science about how the antibodies interact with the CNS. I would also imagine that many PNS disorders will soon be lined to the this as well. I think the atypical facial pain and Cranial nerve neuralgia's will soon be studied too. Getting these people to just have the testing done will help tremendously.

  3. Dave January 28, 2012 at 6:48 pm - Reply

    …my TS started age age five, and just like Dr.K mentions above, TS started with excessive eye blinking. Progressed into rather violent head-shaking during my teens, some sniffling, and a "Bewitched" type of twitch to my nose.

    Oddly, when my early twenties hit, and I started to have all of my hormone problems (like low Testosterone), the tics REALLY subsided. Most people wouldn't even notice them these days (age 42).

    A few years ago my Dr. put me on TRT, Testosterone replacement. Almost immediately, the violent head shaking returned with a vengeance. This was repeated three times over the course of the last five years. Androgens seem to really stimulate the tics.

    Could the lowered hormones be a *protective* response from my body, or more just an after effect due to the damage from the gluten/gliadin proteins??…Dave

    ps…I also suffer from Obsessive Compulsive Disorder (OCD), Sleep Disorder, and mild Bipolar Disorder — and I just tested positive for Celiacs. I was a wheat eater up until a few years ago.

    • Jack January 28, 2012 at 7:21 pm - Reply

      @Dave Well your story fits the blog perfectly……And I am willing to bet there are thousands more like you. You are quite correct that androgens have a major effect on the tics.

  4. Dave January 28, 2012 at 6:53 pm - Reply

    pps…and I've been dealing with an eating disorder for the last 15 or so years too. Damn this blog hits close to home. Thanks Doc!

  5. v January 28, 2012 at 6:57 pm - Reply

    my husband was diagnosed with TS. he had all the symptoms including being oppositional/defiant from a young age. he also go worse at puberty. he was on halodol for a while, but it made him feel like a zombie, so he went off. the kicker: he is chinese and grew up eating rice. he has lots of digestive problems and gas. he has lots of arthritis. he has bad bouts of vertigo every couple of years. my daughter was diagnosed with PANDAS at 10 yo. she was doing eye blinking and rolling. that has gone away, but she still shares many characteristics with my husband- somewhat oppositional-defiant, gassy, more phlegm in the morning.

  6. v January 28, 2012 at 7:05 pm - Reply

    ps tics are more pronounced when my husband is under stress or is very excited. he also has to release his tics when leaving a public place. from reading i did, i try to have him replace a attention attracting tic with a more socially acceptable one, like flicking his knee over and over again with fingers as opposed to making snorting noises. just like i am used to and pretty much oblivious to people staring at me (non-chinese) speaking mandarin chinese with my husband, my husband is oblivious to people staring at him for his motor and vocal tics. he only tried the halodol when someone at his work started ridiculing him. after the zombie side-effects, he decided to ignore the ridicule and go off the medicine.

    • Jack January 28, 2012 at 7:23 pm - Reply

      @V I hope your husband is avoiding the dietary triggers. That is critical.

  7. Dave January 28, 2012 at 7:52 pm - Reply

    Jack…I saw a psychologist when I was age six/seven (some 35 years ago). His cure — I should stare at myself, practice blinking in the mirror. So blink myself to the point of fatigue. He figured that should cure my *desires*.

    Well I can't say that therapy worked very well!…Dave

    • Jack January 28, 2012 at 7:57 pm - Reply

      @Dave I apologize for my profession…….we do this kind of stuff too often to patients. We should just tell them the truth……when we dont know. My opinion is that the answers for most diseases is buried in our DNA and evolutionary medicine. That is why I practice this way now.

  8. Jack January 28, 2012 at 8:25 pm - Reply

    http://glutenfreenp.blogspot.com/2011/08/celiac-a

    Here is a really nice blog write up that people should use as a resource.

  9. Resurgent January 28, 2012 at 10:59 pm - Reply

    Thanks again Jack.! And my salute for leading the rebellion. Only more doctors like you can stop humanity's march towards a robot like existence – sick robots marching dutifully to the hospitals.

    Only the rebellious spirit grows up; its longing is to touch the stars. It is not satisfied with the curent answers. Its contentment is far away; its discontentment is a present reality. The rebellious man has a divine discontent in his heart and a longing to find the real truth. He work is like a pilgrimage.

    Rebellion is individual as opposed to a revolution which is mainly political, It comes out of your authenticity; it comes out of the authenticity of your heart. This distinction is very significant.

    In revolution, and in the ideology of revolution, you try to change the others, you try to change the scene. In rebellion, you change yourself and the scene changes by itself, of its own accord, because your vision is different. You have different eyes to look with.

    Rebellion is spontaneous. It has nothing to do with any ideology. Rebellion is non-ideological. Rebellion is like love; you don't think about it; you cannot think about it. Either you live it or you don't live it; either it is there or it is not there. Rebellion is a happening. If you are ready, you start living a totally different life: the life of authenticity, or whatsoever you would like to call it.

    A rebel simply lives out of his spontaneity; he has no idea what it should be. He acts out of his understanding; he responds to a situation, and a 'Quilt' starts happening.

    Thanks Jack, for all that you are doing for us.

  10. Andrea January 29, 2012 at 3:15 am - Reply

    Jack,

    my sister's oldest son has TS. But she thinks it was the docor's fault. At birth her son almost suffocated from oxygen deficiency. The doc didn't realize it. (Our medical system…sigh….)

    The father did realize that his child is in trouble before the doc did.

    It is known that lack of oxygen after birth is a reason for all kinds of damage. What do you think? Is this a reason for TS independent from all dietary problems? Could it be that her son would be healthy if this accident immediately after birth didn't happen, no matter what his diet was?

    Or should I tell my sister her son should avoid all grains?

    • Jack January 29, 2012 at 10:53 am - Reply

      @Andrea I think you need to read the replay I just made to V……..it is completely appropriate for your sister. If she wants to blame someone she can. But it will never bring her closure. She needs to focus in on what can help her child now and not on what she can't. The more she understands about the disease the better mother she can be to the child.

  11. v January 29, 2012 at 7:44 am - Reply

    i'm wondering if milk might be a major factor in TS- my husband got baby formula- no brest milk at all. i breast-fed my daughter (the one who seems genetically predisposed to tics- and there is a genetic component) except for a bottle of formula in the evening (stARTING AT 3 months old) when i was away at college and my husband fed her. she had colic i think from the cow's milk i drank going into her via breast feeding.

    • Jack January 29, 2012 at 10:51 am - Reply

      @V if you read my post carefully you will see when I speak of ephaptic transmissions they can occur form any type of neuronal damage. When you mention the smoking the natural inclination is to blame hypoxia and low O2 content. You should know that tobacco is the ultimate causer of leaky gut because it has the huge amounts of glycoalkaloids in it just as night shades do. This increases the permeability of the mothers gut, the placental barrier, and it cause a leaky blood barrier in the fetus and causes a leaky gut in the child because of the constant bombardment. The low O2 tension also has an effect no doubt. But when that child is born to such a mother and she then feeds it a bottle with food that fosters a leaky then the pumps are primed for disease. The point of this post was not to say all TS cases are caused by grains……….the point is that we must be mindful of what our brain allows to to do to our own and our fetus detriments. When we are we can avoid and prevent illness. I do think anyone who has any movement disorder would be wise to get advanced gliadin antibody testing because just avoiding grains could save them from other more chronic diseases that afflict us via the same mechanisms. The key is here for people and physicians to realize that these links are present in our species whether we learn about it or not in med school, residency or post graduate training. We have a duty to consider all options. There is already a try serious known neurologic disease that is caused by gluten and I mentioned that in the post. The reason I believe we know about it is because of how devasting and deathly it is for humans who have it. TS does not kill you and neither will most functional disorders so no one is connecting dots…………but I am. There is a way to bio hack every disease when you decide to open the owners manual we all came with and follow it. That book is our DNA and how evolution has formed and sculpted us over 2.5 million years. That is my gold standard randomized controlled clinical trial that I default to now. I am not too impressed any longer by the ones done by science that are paid for by drug companies.

  12. v January 29, 2012 at 7:45 am - Reply

    maybe getting mostly breast milk (until 10 months ) is a factor in why her tics and other behaviors are not as severe as my hsband's.

  13. v January 29, 2012 at 8:13 am - Reply

    "A Cause of Tourette's syndrome

    This condition is most likely due to genetic causes but other factors may have an influence. Women who smoke during pregnancy appear to have a higher risk of having a child with severe symptoms of Tourette's syndrome and the risk of having obsessive-compulsive disorder is also increased in these children. Reductions in oxygen in the womb, a known effect of smoking, could increase the risk of developing Tourette's syndrome in those with a genetic susceptibility."

    my husband's mom smoked during his pregnancy and i remember his mom saying he was the size of a bottle when he was born- so i guess he was underweight as well.

  14. William Trumbower MD January 29, 2012 at 10:44 am - Reply

    Jack I can't wait for your book! I was asked to see one of my patients 12yo daughter. The mother has Hashimotos/gluten intolerance. The daughter had developed abd pain, diarrhea and fatigue. When she came in with her mother, she was using her grandmothers walker because she kept falling down! The daughters celiac panel and thyroid antibodies were positive. I refered her to a neurologist, but obviously placed her on a gluten-free paleo diet. By the time she saw the neurologist (2 weeks), her ataxia had resolved. I am sure that any delay might have made her neurological disorder permanent. For your bloggers-Remember that the uterus and placenta contain the highest concentration of the proteins similar to gliadin.

    • Jack January 29, 2012 at 11:33 am - Reply

      @Dr. T Thanks for the reminder! And thank you for adding more fuel to the fire that can light the path to optimal for people.

  15. Evalinda January 29, 2012 at 1:57 pm - Reply

    Thank you for the post … can't wait for the book!

    My aunt's adopted son (was adopted immediately at birth, now 30 years old) has motor tics. Obviously he wasn't breastfed and was mainly fed with all sorts of pastries – lots of gluten, I remember.

    He doesn't have any associated diseases apart from being overweight (possibly LR). Mentally he is very bright (degree in IT) and did figure out himself that lifting weights helps with his condition, but it hasn't helped lose weight obviously. Now he has taken up weightlifting as a sport and training regular. His coach has suggested him to drink protein shakes, but he also eats wholegrains. But before the competitions (twice) he has been suddenly taken ill, with a very high temp of 40 deg C, which lasted 24 h and then he was back to normal.

    • Jack January 29, 2012 at 2:11 pm - Reply

      @Evalinda……you need to show him this blog then. He needs to cut the grains and work out in cold temperatures. Just trust me on the latter.

  16. Meghan January 29, 2012 at 2:51 pm - Reply

    Fascinating of course. Being off gluten is the best thing I have ever done and slowly in-laws are becoming aware that my genes are in their kids and so they are actually willing to at least listen. Dr. Jack, have you seen the book "Google LDN" and have heard of pts using LDN to deal with motor problems, MS, ALS, et al including the full range of autoimmune problems? Following the GAPS protocol to heal the gut as mentioned before has been the key for me in the last year and it has for many others too. Nothing against any other Paleo or of course your RX, wish I had started the reset earlier, but for me the regimen required with very specific foods to heal the gut had to happen 1st. Thanks for all the incredible work

    • Jack January 29, 2012 at 5:13 pm - Reply

      @Meghan LDN was discussed in the Lyme meets leptin blog and I think I added a section to the chapter in the book about it. It also plays a role in eating disorders. I have a blog in que for 2012 for eating disorders too. The biggest tie is however in the last chapter of my book.

  17. Emily Deans January 29, 2012 at 5:10 pm - Reply

    I know the PANDAS theory was popular, then out of sorts, but new info has made it popular again. I don't see any reason to discount the PANDAS and it seems a very reasonable theory.

    • Jack January 29, 2012 at 5:36 pm - Reply

      @Emily I am not dismissing it. Organized pediatrics did in 2004. There are many paths to disease. But even diseases use fractal patterning. We need to wise up to that in medicine.

  18. Andrea January 29, 2012 at 6:15 pm - Reply

    Jack, thanks for your answer. Very much appreciated. My sister (actually half-sister) didn't "blame" the doc, she just told me that there was this hypoxy ….uhm….episode after birth. And she doesn't smoke.

    I didn't know about grains and Paleo at the time but I knew that hypoxia after birth can be the cause of all kinds of ugly problems. So I just did what I thought was connecting the dots.

    I didn't know that there is a genetic component. No TS in the family. But my sister's nephew has ADHD.

    This post gave me a lot more dots to see and the picture get's much bigger.

    I was just curious whether the TS may be caused by the birth complication. Or in this case "after birth complication". But I understand that testing for gliadin antibodies and avoiding all grains may be a good idea anyway.

    Maybe my sister is like most "normal" people and thinks Paleo is some "fad diet" . Of course I'll give it a try.

    • Jack January 29, 2012 at 6:56 pm - Reply

      @Andrea a birth injury can cause it. This is also a link to eating disorders too because of heightened cortisol levels.

  19. Lois January 30, 2012 at 8:31 am - Reply

    Thanks for all your work! I have a son who has ADHD and at ten still wets the bed. I'll be honest that a lot of your posts go over my head, but I see that you mention ADHD in this post. I had my son GFCF for nine months last year, did a yeast protocol and probiotics. None of it seemed to matter. So now my husband says no to anymore elimination diets. (I started trying everything I read about starting with feingold since he was four). So, I'm just wondering if you have studied it much and if it can be tied to permanent damage? We were also on a semi vegan diet for a few years before I came across paleo…it's sad to think that in my desperation to help him I may have made things worse. Any advice/perspective would be appreciated.

    • Jack January 30, 2012 at 12:48 pm - Reply

      @Lois I think you just need to make sure you eat primal/paleo and your child will follow your lead.

  20. Joan January 30, 2012 at 9:27 am - Reply

    Jack, thanks for another fascinating post. You say this applies to other movement disorders, would that include essential tremor? I've had this since I can remember and was told I was born with it. So at the ripe old age of 55 is it too late to try and ameliorate the symptoms?

    • Jack January 30, 2012 at 12:46 pm - Reply

      @Joan I have a few people with essential tremor that are going to get tested…..so far no one has gotten better with diet alone with respect to the tremor. Its an area I am watching closely for some results.

  21. Lois January 30, 2012 at 9:50 am - Reply

    I also felt I should mention another thing about my son that I have always felt was a big clue but don't know how it ties in…and maybe you will see a connection. He is always way more severe in the mornings-bouncing off the walls, talking excessively, etc- but almost 'normal' calm, but still a bit impulsive at bedtime. I have always wondered if there was some sort of cortisol or circadian tie to it all?

  22. Dave L January 30, 2012 at 11:00 am - Reply

    I think this question has been answered, but I could not find it my searches. Is a leptin reset harmful to one who is not leptin resistant?

    I think I am borderline since I have conflicting symptoms: 6' tall, 195 lbs, about 10-15 lbs overweight (all sub-Q spare tire around waist), I lift weights 2-3X per week, strong cravings for sugar. I eat the BAB, but also have around 100g of carbs (sweet or white potatoes, rice, or fruit- the last of which REALLY sets off my cravings, sometimes I will eat 5-8 apples in one night). Once a week I make an apple crisp with oats and brown sugar. I have to tie myself down like Odysseus and the sirens not to eat the whole thing. I measure my blood glucose. It is between 90-110 right when I wake up, but around 85 the rest of the day (even after a meal with carbs). LDL = 180, HDL = 65, Trigs = 25.

    Should I do the reset or not? Would it be good insurance just in case I am LR?

    • Jack January 30, 2012 at 12:48 pm - Reply

      @Dave L……harmful no……but it likely wont work as described. I would cut all that rice and fruit…..totally and wait to add that back when the light and temperature cycles are better…..I do not add that back until April 1.

  23. Dave L January 30, 2012 at 1:03 pm - Reply

    Thanks!

  24. Marijke February 1, 2012 at 7:29 am - Reply

    Hi Jack,

    I am on the GAPS program for gut dysbiosis and I experience cross talk of nerves regularly. Fi when my gut lining is irritated by the contents of my gut, I feel pain in my back and when it is bad, my back muscles cramp. That way I know something is moving in there.

    • Jack February 1, 2012 at 7:33 am - Reply

      @Marjike I like GAPS but I want you to know it does nothing for those people who also harbor eukaryotic organisms that are infecting the gut. Here in the states the number one thing I see failures with GAPS on is a super infection of CANDIDA. I do not think the GAPS community understands the limitation of the diet. Therefore I created my leaky gut RX to cover all those issues. I think if you are having those kinds of pain you need to consider getting a full GI workup from Genova or metametrix to get to the seat of the problem.

  25. Marijke February 1, 2012 at 9:00 am - Reply

    Thank you Jack. Candida is no longer a problem for me. I still need to get rid of the mercury from the amalgam fillings I had from the age of three. But I will take another look at the leaky gut Rx.

  26. Marijke February 1, 2012 at 12:28 pm - Reply

    Jack, I forgot what eukariotes are, but I think it is single cell parasites like blastocystis hominis and dientamoeba fragilis. I had both. I eliminated the blastocystis by going low carb and taking a probiotic with soil bacteria. For the dientamoeba I used an antroposophic remedy and cut out all probiotics because I found a publication with a photo of dientamoeba eating a bacterium. So it can live off your gut flora. This worked well as was confirmed by a PCR test. Killing dientamoeba gave me the worst pain ever. And now the pain no longer bothers me.

  27. Brenda February 1, 2012 at 4:18 pm - Reply

    I have read that yeast may be the major trigger for TS. Do you agree and would something like an oral Nystatin help clear the yeast out of the intestinal track? I thought this theory worked with the yours because yeast feed of of gluten/grains right?

    • Jack February 1, 2012 at 4:38 pm - Reply

      @Brenda……..without testing you never know if you cleared a yeast. Once yeast grows in the GI tract it must be eradicated.

  28. Joan February 7, 2012 at 6:47 am - Reply

    Thanks Jack. I'm really interested to learn whatever results you get from your other essential tremor patients.

  29. S February 13, 2012 at 12:37 am - Reply

    Do you think this applies to stuttering as well, since it is often thought of as a sister disorder to TS?

    • Jack February 13, 2012 at 7:09 am - Reply

      @S its possible but the complex neural pathways are different.

  30. Joan February 22, 2012 at 6:55 am - Reply

    I finally decided to get my essential tremor investigated. Don't have all my blood results yet, but the ones that have come back so far are normal. I was given a perscription for Propranolol and patronizing advice like "when you write,rest your arm on a table." Like I hadn't figured that one out myself after 50 years. Anyway, I am reluctant to get on the drug hamster wheel and since I couldn't get any answers from this Dr., I'd like to know if this drug would affect leptin reset, sleep, etc. As I don't have high blood pressure, I'm concerned that it will cause dizziness. I am extremely grateful for any advice you could provide. Thanks.

    • Jack February 22, 2012 at 7:44 am - Reply

      @Joan Essential tremor runs in families………in fact, it's sometimes referred to as familial tremor. But studies of identical twins have shown that it's not completely inherited, suggesting an environmental factor may trigger some cases, although what that might be is unknown in most medical textbooks. In my opinion it can be caused by gliadin antibodies or by previous infectious damage as outlined in this blog. Beta blockers, especially a long-acting version of propranolol called Inderal, are one of two main medications used to treat essential tremor. Adrenaline or epinephrine makes tremors worse, and beta blockers, which are usually prescribed for high blood pressure and heart conditions, block adrenaline. Studies show that beta blockers help 45%-75% of patients. Anything that changes the balance of the autonomic nervous system can have an effect on the Leptin Rx reset. The reason is simple. Long standing LR eventually leads to high cortisol levels. Cortisol is the hormone used in the autonomic nervous system to modulate the balance between the two. The goal of the reset is to eventually lower cortisol secretion from the adrenal gland and block the release of CRH from the brain to limit cortisols central effect on the brain. Inderal can actually HELP the reset progress along by reducing your cortisol. So if your 24 cortisols are raised or your diurnal cortisols are off Inderal may help you on the reset side. The main effect for the tremor will be a reduction in movement with actions and maybe an improvement in handwriting..
      The other main drug is primidone (Mysoline), an anticonvulsant. Anticonvulsants work by reducing the excitability of nerve cells. Primidone is about as effective as propranolol, but it can cause nausea, vomiting, and problems with movement, called ataxia. I am not a fan of this drug because it changes the excitability of the neuronal membranes and this can effect the reset tremendously.
      Summary, if you choose to use drugs to treat this condition pick Inderal over Mysoline. The best choice is avoiding gluten, dairy, starches (especially rice which has a cross reactivity with gluten) to see how your tremor does.

  31. Joan February 23, 2012 at 5:11 am - Reply

    Jack, a million thanks to you. You don't know what a relief it is for some one to just give you the facts. I'm a 'Yank' living in Ireland now and Irish doctors seem to get really offended by patients asking questions. It's very frustrating from a patients point of view.

  32. cod4lobbies February 27, 2012 at 10:22 pm - Reply

    Fantastic points altogether, you just gained a new reader. What could you suggest in regards to your post that you made some days in the past? Any sure?

  33. Vicki March 2, 2012 at 4:20 pm - Reply

    I am so glad I started reading your blog after coming off of hCG diet. (Not eating grains and milk on hCG helped my allergies so much I decided to research Paleo.) Otherwise I would not have discovered this link to Tourettes which I hope will help my 38 y.o. son. He has all the diseases associated with Tourettes except for Bi-polar. He does suffer from chronic depression, just no manic phase that we know of. He was anoxic at birth, had terrible colic while on breast milk only, was taken off of breast milk at seven months and put on fat free milk which we didn't realize was not healthy either. So he has a lot of possible strikes against him. He has in the last year undergone brain mapping at the Univ. of Utah and has been on a program to retrain/rewire his brain to deal with his anxieties which does seem to be helping some. I am so hoping that getting him on a Paleo diet will help. Hope we can figure out how he can afford it on his minimum wage. He is working way below his ability because of anxieties brought on somewhat from trying to deal with all of his medical/phsych issues. In spite of all of this he is a pleasant person, just discouraged a lot.

    The fact that both he and I have had terrible GERD and eosinophilic esophagitis plus multiple allergies fits right in with the grain issues. I have had a Nissen procedure performed. He is contemplating having it done also. Is there a problem with the vagus nerve with this procedure as there is with other stomach surgeries?

  34. Vicki March 2, 2012 at 4:39 pm - Reply

    That same son has been diagnosis with Degenerative Disk Disease (which really sets off his OCD worries) and is on a medication for high triglycerides. Though I don't know what the medication is I hope following a Paleo diet can get him off of that med.

    • Jack March 2, 2012 at 8:10 pm - Reply

      @Vicki a paleo diet is a good start but much more can be done. Read about Cold thermogenesis here on the blog.

  35. john March 31, 2012 at 9:44 pm - Reply

    Hi Jack, I have been reading and reading on this site and the web for a long time trying to find out exactly what is wrong with me. I have CFS, and have gone round and round with the medical profession, antidepressives and antipsychotics. Wound up fat, and in more pain. Thank you from the bottom of my heart, this post explains a lot and means that it is not all in my head. I will get the tests. I am trying the cold therapy and have to go slow. This gives me hope that if there is an explanation, then I can get better.

  36. Jack July 29, 2012 at 6:08 pm - Reply

    @Dave http://www.sciencedaily.com/releases/2012/07/120705172052.htm

    Here is some more info on the the skull base genes that we are finding about.

  37. coldbren August 30, 2012 at 3:15 pm - Reply

    What do you think of the role of yeast (or acetone it releases) in tic disorders? My daughter has some tics and we are trying Nystatin (which immediately seemed to make everything worse….maybe a good “die off” sign. We are majority epi-paleo. She is 7 and I just dont know how to help her. Am afraid my selected interventions might make things worse or permanent. My 23andme test show I have a typical risk of tourettes, so I don’t think she would have the gene, but I don’t really know how that works. Thank you for your amazing work, and outside the box magic!

    • Jack August 30, 2012 at 3:18 pm - Reply

      @Coldbren I have no idea in this case.

  38. coldbren September 1, 2012 at 5:41 pm - Reply

    Some people claim food grade h202 can cure it….does this sound possible to you?

  39. coldbren September 1, 2012 at 6:38 pm - Reply

    Also, why do most kid’s tics (non-tourette) go away after a few years?

  40. Stacey August 26, 2016 at 4:24 pm - Reply

    My son always had sensory and sleep issues since he was a baby. Then he began ticcing at age 6. The tics incresed as time went on. He also developed some pretty severe ADHD symptoms and sleep issues. He began intro GAPS diet about 6 1/2 months ago and has progressed into a modified full GAPS (same as full GAPS, just no dairy at all and limited GAPS-approved sugars for a few more months). He no longer tics AT ALL, no longer has night terrors, and does not exhibit ADHD symptoms anymore. He is a happy, normal, well-adjusted child (though still a very intense little person!). Just wanted to weigh in, since there seem to be very few stories about Tourette’s and GAPS diet on the internet, and I wanted to share our experience.

Leave A Comment