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Case History: Jason

Diagnosis: Anxiety
Undiagnosed: Celiac Disease

“His progress has been remarkable.”

Celiac disease is an autoimmune disorder that attacks the lining of the small intestine when a person eats gluten, a protein found in wheat, rye, and barley. It can cause a wide range of problems, including digestive symptoms like nausea and vomiting, anemia, and psychiatric disorders like anxiety and depression. According to a study in the American Journal of Gastroenterology, an estimated 83 percent of the millions of Americans with celiac disease are…undiagnosed or misdiagnosed!

A study of nearly 10,000 children aged 1 to 17 years old, conducted by researchers at the University of Colorado and published in the American Journal of Gastroenterology in January 2021, found that an astounding two percent tested positive for the disease. That turned out to be the case with Jason, a 12-year-old.

Jason (not his real name) had a history of gastrointestinal symptoms and told me he often felt nauseous and “faint.” He also hid allergies to tree nuts, which sent him to the ER on more than one occasion.

And Jason was very anxious, with an intense, overpowering fear of…nausea and vomiting.

In the 7th grade, Jason felt more anxious in a large room with people eating, like the cafeteria at school. In fact, during most of the school day, he found himself thinking uncontrollably about getting nauseous and vomiting—and tried to stay out of school as many days as possible.

He was afraid of eating because he didn’t consider food “safe,” and he’d lost five pounds in the months before I saw him. He was afraid of sleeping, because he thought he might vomit during the night, and his sleep was disturbed.

Jason was first seen by his pediatrician, who had prescribed Lexapro, 5 mg per day—with no response after 3 months.

His family psychiatric history revealed bipolar disorder type 2 (mother), obsessive-compulsive disorder (maternal uncle), and generalized anxiety disorder (maternal grandmother).

Testing and bloodwork, revealed the following:

I wanted to conduct Functional Medicine testing including trace mineral hair testing, Organic Acid Test (OAT) and test for kryptopyrrole (KP) but couldn’t do so because of Jason’s fear of needles and expense of the tests.

I was able to do genotype testing, which revealed that Jason had the MTHFR mutation C/T (an inability to fully metabolize the B vitamin folate).

I recommended L-methylfolate (a form of folate not affected by the MTHFR mutation), 2.5 mg per day, and a magnesium supplement. But Jason wouldn’t take supplements because of his fear of nausea and vomiting. However, his parents convinced him to take Zoloft, 100 mg, every night before bed. The Zoloft helped decrease his anxiety, enough so that I was able to complete two urine tests, Kryptopyrrole (KP) and Organic Acid testing (OAT). (Jason still had intrusive thoughts about nausea and vomiting, often felt faint, and said his palms were sweaty throughout the day.)

Testing results showed very elevated kryptopyrrole 49.97 (normal ranges under 10), a compound that can cause deficiencies in vitamin B6 and zinc. I added zinc picolinate, 15 mg twice per day; and vitamin B6, 25 mg twice per day.

On this new regimen, Jason had a significant reduction in anxiety, which allowed for bloodwork, including a celiac disease comprehensive panel. …which was positive for celiac disease! The bloodwork also showed Jason was very low in ferritin, zinc, vitamin B12, and vitamin D.

I adjusted the treatment plan accordingly. We eliminated gluten from Jason’s diet. He started to take iron, vitamin D3, 5000 IU per day; vitamin B12, 2000 mcg sublingually per day; and a multivitamin that contained zinc.

After one month on the new treatment plan, Jason’s improvement was, well, dramatic. His anxiety levels dropped, and he reported no intrusive thinking about nausea and vomiting. His physical symptoms were infrequent. He was able to go to school every day and stay in school all day—and he joined the basketball team. He continues to have some social anxiety. But overall, his progress has been remarkable.

Want to learn nutritional and functional medicine interventions like these to help your patients? Enroll in our comprehensive Fellowship for mental health providers! Book a private phone call with Dr. James Greenblatt to learn more today.

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