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Nancy O'Hara

Treating Chronic Neurodevelopmental Conditions In Children with Dr Nancy O’Hara

Nancy O'Hara

Treating Chronic Neurodevelopmental Conditions In Children

Joining us today is renowned Integrative pediatrician Dr Nancy O’Hara. In this episode, we explore pediatric care for children  with neurodevelopmental conditions such as ADHD, ASD, OCD, PANS and PANDAS,

Dr O’Hara walks us through her assessment and treatment strategies of these complex conditions and reminds us that children with neurodevelopmental conditions are like gifts wrapped in many layers of wrapping paper and how it’s our job as practitioners to unwrap these layers to reveal the gift inside.

About Dr O’Hara

Dr Nancy O’Hara is a board-certified Pediatrician and a key member of the Designs for Health Scientific Advisory Board. Prior to her medical career, Dr O’Hara taught children with autism.

She graduated with the highest honours from Bryn Mawr College and as a member of the Alpha Omega Alpha Honor Society from the University of Pennsylvania School of Medicine. She earned a Master’s degree in Public Health from the University of Pittsburgh.

After residency, chief residency and general pediatric fellowship at the University of Pittsburgh, Dr O’ Hara entered general private practice in 1993, and in 1998 began her consultative, integrative practice solely for children with special needs.

Since 1999 she has dedicated her practice to the integrative and holistic care of children with neurodevelopment disorders, ADHD, PANDAS/PANS, OCD, Lyme and Autistic Spectrum Disorder at the Center for Integrative Health, where she is a partner. She is also a leader in the training of clinicians, both in the United States and abroad.

Connect with Dr O’Hara:

Website: drohara.com

Transcript

Introduction

Andrew: This is “Wellness by Designs.” And I’m your host, Andrew Whitfield-Cook. Joining us today is Dr Nancy O’Hara, an integrative pediatrician of great renown and who has visited Australia on a number of occasions. Dr. Nancy, I’d love to welcome you to “Wellness by Designs.” How are you?

Dr. O’Hara: Great. Thank you. And thanks for having me, Andrew. I really appreciate it and glad to do it.

Andrew: It is my pleasure, my honour. I’m finally getting to speak with you because I missed you at the…what is it? 2019 Mind Forum. But anyway, let’s go back into your history. How did you first, as a doctor who is taught, you know, quite strict guidelines of how to think and work? How did you get interested in functional medicine? What changed to open your mind?

Dr. O’Hara: Well, first of all, I come from a family of physicians, very tried and true general practitioners. I started my career as a teacher of children with autism and was pretty lousy at it. So went to medical school thinking I would become a psychiatrist and work with those children exclusively, but instead became a pediatrician and was in a partner in a general pediatric practice when one of my patients who was four and a half at the time had severe allergies, a typical toddler diet, you know, everything white carbohydrates, dairy, etc. I was trying to get him off dairy, and he went away with his family on a vacation and developed a diarrheal illness, called our office and our nurse said, “Well, stop the dairy, it’s making the diarrhea worse.” And she stopped the dairy, and he started talking for the first time. And mom called me and said, “I’m working with him full-time. I’m gonna do that when we get home. Something’s changed. I don’t know what it is.”

They got home, he got over his illness, they put him back on dairy, he stopped talking. She called me and I said, “Well, it’s the flight, it’s the transition, etc.” And thankfully, she didn’t believe me. And she did the same trial several times. And I’m not here to say you have a child with autism, take him off milk and he’s going to be cured. But it made a difference for this one child. And she came back to me and she said, “You have to look into functional medicine.” Now, at the time as a very traditional physician, I wasn’t sure I could do that. But I was going through four years of infertility, and nothing in western medicine, allopathic medicine was making enough difference in my life. And so I went to see Dr. Sidney Baker as a patient, and that changed my life. And I spent the next several years learning through Sid, who’s the grandfather of the Institute of Functional Medicine, through conferences, through a lot of reading what it really meant to be a functional medicine physician and started integrating that into my regular practice, and then opened my own practice solely for the integrative care of children with neurodevelopmental problems about 23 years ago now.

Andrew: Right. I do want to say that as a pediatrician, I mean, you must just get battered by heartbreak of so many condition, I mean, pediatric oncology. I don’t know how anybody continues to work in that without burnout. But seeing this child, normally, I have this memory of somebody telling me imagine your child and somebody is building a brick wall in between you and them until finally the final brick goes in place and you’re cut off from your child. But this happened very quickly apparently.

Dr. O’Hara: It did. And again, you know, that’s less than 6% of children, but it was what opened my eyes, and there are a couple of things. One of Sid’s phraseology is, “Have we done enough for this child?” And that is something that I look at with every child. And you talk about that brick wall and brick by brick, and that’s very true. And usually, that’s the way we need to help children through functional medicine, but I like to look at it as a gift. And that child or any child is a gift, in and of themselves. Now, some of them, like that little boy are wrapped in many, many layers of wrapping paper. And it is our job, I think, as clinicians and as parents to unwrap those layers one by one, but also to see the gift, whether that child is wrapped in nine layers, or we get to see the true gift inside. And that’s what keeps me going and is trying to find the gems, the pearls, as well as the root causes in each child that may help me help the family unwrap them.

Andrew: It’s interesting that you say the word gift because so often these kids…I’m reminded of a few that my wife, she’s a teacher aide, and she helps these kids when they explode. And, you know, they’re very driven in a certain area. But like, for instance, one knows all about astronomy, and the other one knows all about dinosaurs. And the knowledge is incredible particularly for…we’re talking about, you know, like an 8-year-old, the knowledge and pronunciation of names that an adult has issues with of these complicated dinosaur names and astronomical terms. So I’ve got to ask this question about is a properly-treated autistic child…are we actually robbing them of a gift, or does it allow that gift to blossom?

Dr. O’Hara: I think it’s the ladder, as long as we look at it in that way. I remember one of my first patients who came here from Melbourne, two children, teenagers with autism. And the parents said to me, “We want to do whatever we can do to help our children reach their fullest potential. But don’t make any mistake, we love them just as they are.” And I think as long as we look at it in that way, we can really help both the child where they are and where they could potentially be.” The other thing that I want to say about what you were saying, Andrew, is that these children are in there. Whether they can say nothing to us or are astronomically intelligent, they get it. And we can never forget that as we work with them, talk with them. And a lot of Elizabeth Fausey’s work is showing that. You know, we have 25-year-olds now who we thought had an IQ of 50 and never spoke and could never do anything that now at 25 know 3 languages and have encyclopedic reading and a wicked sense of humour, but we never knew it because they couldn’t talk. But we have to keep that in mind with all of these children and not discard them or fix them in any way.

Andrew: Right. Okay. And of course, therein lies the issue of functional medicine. So tell us about functional medicine as it applies to pediatrics and I guess with a bent for helping those kids with neurodevelopmental issues.

Dr. O’Hara: Yes, and certainly, that is my bent. But with allopathic medicine, and this is another citizen, it’s name it, blame it, team it. You know, well, it’s ADHD, or it’s autism. So that’s what it is. And now, we’re going to blame all the behaviours on that, and then we’re going to prescribe a medication to change those behaviours. Instead, what functional medicine does is it looks at the root causes. Certainly, it’s a genetic disease, but genetics loads the gun and environment pulls the trigger. So where is this child immunologically? What’s going on in their gut or their gastrointestinal system? What’s going on in their metabolism? What’s going on in their mitochondria, the energy cells of the body, and looking at all of those and trying to figure out what were the triggers?

And usually, it’s not one trigger. A childlike the first one I described may have only one trigger. But in most of them, it’s multiple triggers. And it’s trying to figure out what that is, and how then we can impact that. I think the second piece of functional medicine is always remembering that food is medicine and that the gut isn’t the second brain, it’s the first brain. And unless we treat the gut, unless we treat constipation, malabsorption, leaky gut, or gut permeability, we’re not going to be able to add any nutraceuticals or help this child get better. So it all does start in the gut. Even for children that have perfectly normal stools and don’t seem to be in any pain, we need to make sure that their gut and therefore their immune systems are working optimally.

Andrew: Now, that’s a very interesting thing you say about the gut and we’re talking about neurodevelopmental issues. If we’re thinking about molecules like casein and the casomorphins action, how kids with ADHD, particularly ASD and autism are…they’re addicted to wheat. They’ll turn a toaster upside down to get crumbs if you won’t let them eat wheat. You know, they’ll do anything they can. That’s a true addiction. So is that part of these molecules action on the brain? And if we heal the gut, is that blocking the absorption of these molecules through the gut-brain superhighway?

Dr. O’Hara: Well, that’s an interesting question because there are really three parts to gluten and casein, and you mentioned one of them, the casomorphins, gluteomorphins. That is the protein that acts very much like a narcotic, like heroin on the brain, and causes quite addictive behaviours. The second way gluten and casein can be problematic is that it blocks a part of our detoxification pathway. So children who have problems absorbing casein or gluten cannot effectively work their methylation, sulfation, detoxification pathways. So removing those foods can help in that way. And then gluten, and this is through work of Alessio Fasano and others, causes gliadin to build up in the body, and gliadin, those gliadin antibodies cause zonulin to be produced in all of us. And that zonulin increases the gap junctions, the leaky gut, the gut permeability.

And when that happens, most people can tolerate it. People with celiac disease, like myself, can’t tolerate a spec. And many of our children with gluten sensitivity also cannot tolerate it. So that leaky gut or gut permeability, widened gap junction, allows inflammation antigens to get into the system and doesn’t allow appropriate absorption of nutrients, minerals, vitamins, good nutrients from foods. And so gluten and casein are sticky wickets for several different reasons. And that’s why in all of our children on the spectrum at least, in many of our children with other inflammatory disorders, I’d say do a trial. Get off of it for 100% for three weeks for casien, three months for gluten. And then if you’re not sure you see any difference, pick out on those foods, eat a lot of those foods for two or three days and see if there’s a regression in gut function, in cognition, in behavior. That’s really your proof, much more so than any test or verbiage for me. It’s really a trial in your own child.

Andrew: Yeah, it can be really powerful, the avoidance and then challenge when you’re just really heated up and you’re going nuts. I have to ask, though, because we’re talking about these casomorphins, gluteomorphins, many of us, I’d say do they can be, but anyway, they don’t affect many of us. And so, you know, you’ll get your naysayers to functional medicine saying, “But milk and wheat have been around for aeons, and we’ve handled them, we’ve tolerated them. Indeed, they’ve nourished our society into the civilization,” I’ll use that in gibs, the civilization that we call it today. So what’s the difference between these kids with neurodevelopmental issues? Are we looking further into how they react with genes? I noticed that you mentioned, you know, their detoxification pathways. What seems to be different? Are we dealing with one or two things or a whole host of things that are different in these kids?

Dr. O’Hara: Right, I think there are a couple answers to the question. So, first of all, many of our children may be much better if they lived 100 years ago because it is also about how we may have modified our foods over time. Not just non-organic foods and GMOs, but the modification of our wheat products in general. And that’s much more a problem, I think, here in the States than in many other areas of the world. The second thing is that it is multifactorial, and I think genetically, and sometimes compounded by that environmentally, our children with severe nerve developmental issues are our canaries in the coal mine. And I grew up in Wheeling, West Virginia, which is one of the coal mine capitals of the world. And when we were testing out a mine, not me personally, but when the miners were testing it out, they would send canaries in first. And if the canaries died, that meant the mine was too toxic for the minors. Our children with autism are our canaries. And I think they are showing us what all of us and what future generations may be susceptible to if we don’t modify and learn from all of the issues in our environment, not just gluten and casein, but glyphosate and chemicals and toxins in general.

Andrew: Yeah, sure. I want to also ask you about something which Dr. Elisa Song first alerted me to. And that was, I think, four-odd years ago now, devastating disorders that have been almost ignored by the health authorities, PANDAS and PANS. Can you take us through a little bit of what’s happening in this area, and in fact, some of the other hallmarks of when you’d suspect it as well, but also how you treat it. I know this is a whole seminar. I get it. But if we could just go through a few clinical pearls, that’d be great.

Dr. O’Hara: Yes. So Russell Dale coined the phrase, “autoimmune encephalitis of the basal ganglia,” and that’s really very descriptive of what it is. It’s inflammation where the body’s own proteins are attacking a part of the brain, the basal ganglia, and causing inflammation. PANDAS stands for pediatric autoimmune neuropsychiatric disorder associated with strep, and was first…that’s a mouthful. It was first coined by Sue Swedo in the 1990s when she found that children who had a strep infection within the 6 weeks to 12 weeks prior would present with tics, OCD, anxiety, and choreiform movements, which are abnormal involuntary movements of the small muscles. And this was very similar to Sydenham chorea, which were the big involuntary movements that people with rheumatic fever and neurologic problems subsequent to that would show.

So, in 2012, this was still a very controversial subject, do you believe in PANDAS? And so 30 practitioners got together to try to make it less controversial and had found that there were other triggers besides strep that could do the same thing, mycoplasma infections being one of them, which is an atypical bacteria that often causes bronchitis or walking pneumonia, viruses. I think yeast should be among those and other changes within the metabolism that may be caused by anesthesia, toxic exposures like acute onset of pesticides exposures. And all of these caused an abrupt onset of neuropsychiatric symptoms. So PANS was coined. And that involved the abrupt onset of OCD or anorexia, a very atypical eating disorder where it was an OCD of eating and two of seven other criteria, and that included somatic symptoms like an abrupt onset of urinary symptoms, bedwetting, wetting during the day, urgency, or sleep symptoms, particularly what we call REM disinhibition, which means they become very restless sleepers, anxiety, particularly separation anxiety when they go to bed, or separation from mom.

And this is not in a 2-year-old. This is in a 9-year-old, an 11-year-old that was previously going to bed just fine or going to school just fine. Behavioural regression, your 11-year-old that starts talking like a baby, or only wants to watch Thomas the Tank Engine videos, motor disinhibitions or clumsiness where handwriting deteriorates, or they become clumsy in physical education, sensory abnormalities, where it’s the 0 to 60, one minute they’re fine, the next minute they’re crying, or abruptly angry, raging, showing aggression towards self or others.

And then finally, abrupt cognitive changes and abrupt onset of attention deficit disorder. The hallmark of this disorder, though, is the abrupt onset. This is not a subacute or a chronic onset. This is not a child with autism that has been having this for 10 years. It is a child that may have autism, but on February 12th was fine and February 20th is devolved into wetting, or sleep disturbances, or anxiety together with tics. It is a child that was totally neurotypical. And over the course of one to two weeks becomes incredibly anxious, or having OCD, or having intrusive thoughts. So the abrupt onset is the hallmark. And then the treatment…so that’s most important is understanding that because what a lot of people say then is they start doing the lab tests and say, “Well, the strep markers are normal, so it can’t be PANDAS, or Mycoplasma is negative, so it can’t be that.”

The hallmark of this is the clinical diagnosis, the labs may prove or not what you find clinically. So the treatment is threefold. One is treating the underlying infection, so that may be with antibiotics or antimicrobial herbs that treat the infection that you think is most likely to be causing this strep, mycoplasma viruses. Now, I’m not leaving out Lyme or mould or other things like that, but those are usually much more subacute and really should be thought about but not put in this category specifically. So one is the antimicrobials. The second is anti-inflammatories, immune modulation. So, in the allopathic world, that’s intravenous gamma globulin. In the functional medicine world, that often starts with quercetin, curcumin, aloe, specialized pro-resolving mediators, multiple different anti-inflammatory and immune-modulating interventions, including diets that are very important in lowering the inflammation.

And then the third is symptomatic relief. For example, if the child all of a sudden can’t sleep, you’ve got to start with getting them to sleep. If the child all of a sudden has tics, you’ve got to start with treating those tics. And so we use a lot of nutraceuticals, vitamins, minerals, and test for those, as well as anti-inflammatories in treating this. And then the last piece of this is that it is an episodic course. There is a waxing and waning. If you catch it early, it is fully treatable, which is why it’s one of the things I lecture about, I’m writing a guide book about, I work on on a daily basis because we want to get the word out to all types of practitioners to treat this as soon as you suspect it because those kids can get better much faster. But it can come and go with the next strep infection, with the next virus, with the next anesthetic or pesticide exposure.

And so you also want to make sure that you’re educating the families about what to look for and having either prevention of future bacterial infections, or what we call, for instance, an acute viral protocol to be ready when they’re exposed to something to try to dampen any further regressions or effects of this. But it is treatable and it is something that it’s very near and dear to my heart. And I will put a little plugin for my colleague. Dr. Lindsay Wells is a naturopath I work with, and she has recently written a children’s book about Super Sam and his family. And it is something I recommend to families, both as an easy read, as well as something to help the siblings of these kids because so many of the children, it’s an overnight change in their brother or sister, and mom and dad are so focused on that sibling that they forget about the sibling who is still healthy. So it’s a great little children’s book and Dr. Ed, one of the docs in our practice and I are in there trying to help all of our families get better.

Andrew: You know, that’s a really good point you make. Any disease, any disorder that affects one affects the family unit, particularly with kids where you’ve got the caregivers, the parents, they’re worn out, they need support as well. You mentioned something earlier on about the testing. And I remember Elisa Song talking to me about that you’ve got to do the correct test. And forgive me, I’ve got anti-endomysial antibodies, which has got to do with gluten enteropathy. I get it. But there’s a DNase test for PANDAS, is that right?

Dr. O’Hara: So there are two main blood tests that are available at any local laboratory. And ASO, which is an anti-strep to lysozyme antibody and an anti-DNase antibody, both are very important, but again, can be negative and it still be PANDAS. So if they’re positive and the clinical history fits, great. What is most likely to be positive is actually an ANA, an antinuclear antibody. That is positive in greater than 56% of children. And so if that’s positive at a low nonspecific level, then I definitely know I’m dealing with autoimmune encephalitis and I’ve got to dig deeper into the history, the physical exam, and the testing to see what I have missed.

Andrew: Gotcha. And also, you’re mentioning some of the things you use in helping these kids. And, you know, one of the things, when you’re talking about tics that was really interesting to me, was using NAC. What’s your experience in this? And the reason I’m saying this is because there’s a trial that’s done in multi-centres across Australia for a totally different disorder. They’re using N-acetylcysteine for ice addiction. And they’re working on the dopamine. Yeah, but it’s really interesting. So tell us about your experience with using NAC with tics and other issues, detoxification, for instance, in these disorders.

Dr. O’Hara: Absolutely. NAC is one of our favourite eye interventions for OCD. There are more than 17 published studies on the positive effects of NAC on trichotillomania, which is obsessive hair pulling on gambling, on alcohol addiction, on skin picking, on multiple different types of OCD and many animal models too. The OCD of animal models is often marble burying, you know, burying a marble. Anyway. So we use NAC quite frequently. The other thing that’s important when you mentioned the detoxification is NAC is one of the precursors of glutathione. Glutathione as we know is one of our major detoxifiers of our body. Glutathione may not be well-absorbed orally, but NAC certainly is. One thing to keep in mind with oral supplementation with NAC is it does oxidize to the air. And when it oxidizes, it is less bioavailable and often will have more of a sulphur smell.

So what I recommend to families to do is when you buy a bottle of NAC, get some little blister packs, little Ziploc bags and take out a daily dose. And the studies so far are looking at 1,800 to 2,700 milligrams per day and take out a daily dose and put each daily dosing in an individual packaging, and that will help. So that when you often will hear the first couple of weeks of using it, a child does much better, and then after that, they don’t seem to do as well, well, probably because you’ve gotten to the bottom of the bottle. If you take it out and keep each daily dose closed, it can last and be much more bioavailable.

Andrew: That’s a really salient piece of advice for manufacturers of NAC, isn’t it? Maybe we should be looking in a smaller, airtight dosages. I know it’s different. You’ve got different regulations between countries, U.S. to Australia. But I think that’s a very good piece of advice that we should all heed. Nancy, can you take us through how you support that sort of family unit, and particularly when you’re dealing with a child who is unaffected, having to go along with the family changes with diet and lifestyle and things like that? How do you actually support that whole unit? Must be so difficult.

Dr. O’Hara: Well, first of all, it’s similar to what I was saying about the child with autism. You first have to recognize every piece of that family unit. It’s one of the reasons we require or request strongly that both parents be involved in the initial, that we ask about other siblings. And one other thing that Sid taught me is if you listen, they will come. And one of the biggest things, we have lots of boxes of tissues in our office because often what families will say is, “You’re the first person that listened to us, that heard our story.” And I think that’s really important as clinicians to listen to the family story, to hear them out and hear the siblings out. I had a young man whose brother would leave post-it notes, “I hate PANDAS.” And it was one of the reasons we started talking to the siblings more and helping them more.

I think a couple of other things that are really important, one of the phrases we often use is, “Don’t feed the beast.” You know, because this child is ill, whether it be with autism, or autoimmune encephalitis, PANDAS, whatever it is, that child should still have expectations within the family unit. And coddling that child does not help them to move forward from this problem. There are children that keep having problems. Remember, I said it was an episodic course, where children with autism may recover, but they may still have parts of their personality that are very difficult. We need to make sure that child within the family unit also has expectations, and also that everyone is hurt. And then the last piece of that that I would say, and this is a woman who prior to the last two years really wasn’t a very good cook, but in the last couple years, I have gotten pretty good.

But as a not very good cook when my family was young, everybody had to eat the same. And I think it is important if, for instance, you’re going to go gluten-free or casein-free or try to do an anti-inflammatory diet, that it’s not for this one child, that everybody in the family is part of it and doing that for everyone. And then if that child who is not ill gets a special time with mom or dad where they get to go for a pizza, or get to go for that milkshake that the affected child cannot have, great. But the more the family can all be together on this, the better. And then the last piece I’ll just say is, and this is one of my other colleagues, Vicki Kobliner, who’s a dietician in our practice taught me, is make sure you let all of your children know I get it. I understand. And sometimes that’s even when you don’t. But if they feel heard, if they feel like you’re trying to understand where they are, then each of them in their own way may be more compliant or more working with the family as a team.

Andrew: Nancy, I’m gonna ask you about just a few things on…I guess this is does this allow you to cheat? So there’s been some talk some years ago about various proteolytic enzymes which might help digest gluten to some degree. There’s various different types of milk like the A2 milk, which has a different casein in it. Do these supplements and food choices allow you to cheat a little bit, or is it really, “No, you just can’t have it”?

Dr. O’Hara: The answer truly is yes and no. So, first of all, during the trial period that we were talking about, the answer is no, no cheating, no infractions, no enzymes, 100%. And it is not okay if it’s 99.9%. Do it when you can be 100% compliant. And if there’s an infraction, then that next day is day zero in that counting of three months. But after that period, let’s say you do the pig-out and there’s no regression, there’s been no improvement during that time, then if a child, for example, has autoimmune encephalitis, my preference would be to keep gluten and casein out of the diet in the home as much as possible. But when there is a special night, a pizza night, or certainly when there’s something like a birthday party, or going out with friends, or something like that, then using the enzymes in that way, using the other things to support digestion and gut health can be very helpful. But it depends on the severity of the sensitivity. If it’s a true allergy or celiac disease, then there’s no wiggle room. But if it is a sensitivity, then when there are infractions using the enzymes may be helpful, but certainly not during that trial period and certainly not if there is a remarkable change like that little boy that we first started talking about.

Andrew: Being part of functional medicine, of course, is using both allopathic and natural medicines. So how do you blend the use of orthodox medicine for, let’s say, ADHD, which we know now have a huge impact later in life for like increased suicide risk for older adults, for adults with ADHD who have been treated as children? How do you not just try to manage the condition that they have when they’re kids and when they’re growing up, but also being alert to how the drug is impacting the body as well? Is there any hints and tips you can give us here on how you co-manage that with nutrients how to lessen the negative impacts?

Dr. O’Hara: Absolutely. So first of all, with functional medicine, we try to look at all the other reasons. I’ll just give you one child who I was taking care of when I started this practice, but it seemed for quite a few years in my typical practice, and I was about to put him on an ADD stimulant medication. I left that practice and they followed me here. And for the first time, I took a dietary history, and he was eating nine bananas a day. And we removed the bananas and the teachers were so thrilled that I had finally put him on the stimulant because he was a totally different child. But he had a phenol sulfurtransferase defect and couldn’t tolerate that. So I talked to families about looking at all the other reasons and also looking at natural agents that may help attention and cognition, looking at essential fatty acids and oils, which we get very little of in our sad standard American diets. But looking at that, looking at supplements like Bacopa that are in many good nutraceuticals, looking at B vitamins, looking at all of those that can be very helpful and either reduce the dosing of an ADD or ADHD medication or eliminate it altogether.

Secondly, we always look at the atmosphere, and we talk a lot about what’s going on in the home, in the classroom that may be blocking this child from receiving the information as well as they should. Do they have an auditory processing problem, a visual processing problem? Do they have brainwave dysfunctions that could be altered by neurofeedback, for example So we look at all of those things as we’re trying to help this child either reduce their medication or support them in other ways. Then finally, if they are on that medication, then we will use a lot of nutraceuticals that help with gut health as well as help with detoxification, to detoxify these through the cytochrome P450 or other liver detoxification pathways so that the problems of the medications may not be as great.

Andrew: Now, forgive me, you were mentioning a transferase enzyme there with regards to bananas. How the hell did you pick that up? That’s detective work.

Dr. O’Hara: Yeah. I mean, it was really just…I mean, to come to our practice now, there are at least 30 pages of a questionnaire you need to fill out. And one of them is a three-day diet history. And so seeing that and seeing nine bananas a day, and then when we remove them seeing this totally different child, then I was able to go back and do the snips, do the DNA methylation profiles, and prove it. But if I hadn’t seen that diet, I’m not sure I would have even looked for it.

Andrew: Now, that’s an interesting thing about doing…like you do your case history first that gives you a reasonable suspicion that there’s legitimacy if you like to do snip testing. Some people favour just do the snip testing because you’ve got it anyway. But sometimes I’m…I waver here because sometimes I’m of the mind of, you know, then do you actually look for a nail to hit, you become the hammer? But I love your way of having the knowledge to sift through things to have reasonable suspicion to do a test. And I guess that actually comes from your allopathic training. You don’t just do tests, you have a reasonable clinical suspicion to do that test. Is that what you teach people?

Dr. O’Hara: Absolutely. And it absolutely comes from, A, my upbringing. You know, growing up in a coal mine town in West Virginia, nobody had the money for tests. You know, I was going out into the boondocks with my parents and free clinics, and all they had was their stethoscope in their ear. And so I learned from them that you can learn a lot just by talking and listening. Then, as my mentor is Dr. Baker, that is what functional medicine is really based on. And I think whether it’d be allopathic medicine or integrative medicine, if we’re basing what we do on a test, we’re missing the child or the patient. And we have to always start with the child’s history and physical exam, I think, and then move on from there to do the testing. So it’s very individualized.

Andrew: And just a last question with compliance. Now, these kids are very often, you know, non-compliant, to straight out, non-compliant. But what I find really funny is sometimes if you can get that child around the barrier of having to take something, sometimes their rigidity can actually make them the most compliant once they see a benefit. Do you find that in your practice? Like, how do you get around the barrier to…? Yeah.

Dr. O’Hara: Yeah. So, first of all, I try to find the hook. I try to find the thing that will help that child the most and start there. Another child in my practice, he was an 11-year-old at the time, who I knew removing dairy would make a big difference. And so I got him to contract with me, “Look, three weeks. Just do this. If it doesn’t work, you don’t have to do anything else.” And he did, and he was miserable for the first few days like an addict would be. And he locked himself in his room, wouldn’t come out, barely ate at all. And after the fourth day, he came out, and he said, “I’m never having dairy again.” Now, he’s a kid that I now know in his 20s that will still go to a pizza party. Now, here’s one where he used that enzyme to have one pizza so he can be like everybody else. But he won’t get the ice cream and he won’t eat the fluid milk, but he still knows that has a tremendous impact on him. So it’s trying to find that hook for either the older child who has to buy in, or the parents who have to buy in and feed the younger child.

You know, when they’re little they’re not going to the grocery store. You know, you only have to get the parent to buy in to shop on the outside of the grocery aisles at least here in the United States so they’re getting the fresh foods and fruits, vegetables, meats, nuts, and not getting any of the packaged food. They do that, you’re awesome, you’re halfway there. So, again, it’s trying to find that one little thing. And then it’s also about working with the family. Okay, they like liquids, well, then let’s get a little bit of cherry syrup or something like that and put it in a shot glass and get them to down everything together. They prefer pills, okay, well, let’s put everything into pills. And even if it only comes as a liquid, you know, find somebody that will put 12 drops in a veggie cap and give it to ’em that way. So learning how the child will take things makes a big difference too. And I wish I could share a screenshot that I have on my computer, which is a little boy holding a big bunch of supplements. And he said to us the other day, he said, “I never thought I’d take all of these, but I feel so much better.” You know, this is a gift and he’s holding them like they are a gift.

Andrew: You know, it reminds me of something Frank Golik. Damn him for making me cry at the Mind Forum. But, you know, the results that he got in this child were just heart-rending when the child went back, but so beautiful when he was successful. And, Nancy, it’s so obvious that you get these successes again. I wish we could talk more. These conditions are so complex that we can only touch the tip of the iceberg with a 40-minute interview. But I would love to welcome you back to delve into certain ones in more depth at some later stage if that suits you.

Dr. O’Hara: I would be glad to. I love to talk.

Andrew: But it’s not just the talk, it’s the care and the way… One of the things that impresses me about you as a doctor is that you don’t put yourself above others. You say you learn from your nurse, you learn from the dietician, and I think that’s really telling about you as a practitioner. Thank you so much for joining us today on “Wellness by Designs.”

Dr. O’Hara: Thank you, Andrew.

Andrew: And of course, thank you for joining us on “Wellness by Designs” today. You can find all of the show notes and the other podcasts on the Designs for Health website. And of course, I’m Andrew Whitfield-Cook. This is “Wellness by Designs.”