PANDAS and PANS with Dr. Jill Crista: Rational Wellness Podcast 372
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Dr. Jill Crista discusses PANDAS and PANS with Dr. Ben Weitz.
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Podcast Highlights
1:39 Dr. Crista became interested in studying and treating PANS and PANDAS because she had two twin kids with PANS and this was before it had a diagnostic name. Her kids were pretty normal and went to school and played sports and all those sorts of things. So many of the other parents brought her their kids with various neurological things going on. The tie between mold and PANS and PANDAS is that mold can become the trigger.
3:38 The most common signs and symptoms of PANS and PANDAS include emotional symptoms like anxiety, separation anxiety, OCD, tics, and also urinary frequency, generalized abdominal pain, not wanting to leave their room, aggression, irritiability, and the inability to write well. Exposure to mold, weed killers, herbicides, heavy metals, as well as Lyme and various other types of infections.
Dr. Weitz: I mean, cause we know most of these infections are low grade chronic things. And a lot of times we see even in mold, it seems to be a slow developing chronic thing.
Dr. Crista: [00:08:00] Yeah. So by the clinical criteria, yes, it needs to be acute. Where it gets a little wiggly is if it was acute and mild, then we can miss it. Usually, the classic story, the classic case is, the kid gets strapped, three weeks later, they change overnight, and they have tics, OCD, they can’t leave their parent, they have the anxiety, they have, all of a sudden this is a different kid. And that can be anywhere from right after the infection, during the infection, usually not during because usually it’s like a secondary response, but it can be up to three to maybe even six months after that infection to fit the clinical criteria that you have a kid that just overnight changes, the parents will say, I feel like our kid was just like a body snatchers, they came and they took it and they put a monster inside of my kit instead.
And it’s very scary. And these kids can get extremely scary, sick, they can start to feel like maybe their parent [00:09:00] is an imposter. So they get afraid of their parent, one parent and clingy to the other, so there’s a lot of, the brain just doesn’t work right when it’s so that’s the classic picture.
However, and I talk about this in my book on the definition of PANS, the reason that we even created a second thing from PANDAS is they found out that, wow, not all of these cases that are classic had strep. Some of them got the flu. A lot of them. Flu is a big triggering infection for kids. Also Mycoplasma Pneumonia, Chlamydia Pneumonia.
Dr. Jill Crista is a Naturopathic Doctor and the author of Break the Mold: 5 Tools to Conquer Mold and Take Back Your Health and now of this new book, A Light in the Dark for PANDAS and PANS. Dr. Crista offers several popular physician training programs on both Mold and also on PANDAS and PANS, as well as a course for patients on mold. Her website is DrCrista.com.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast. Hello, Rational Wellness Podcasters today.
We’ll be speaking about Neuropsychiatric illnesses in children, referred to as PANS and PANDAS, with Dr. Jill Crista, who has a new book on this topic called A Light in the Dark for PANDAS and PANS. PANDAS stands for Pediatric Acute Onset Neuropsychiatric Disorders Associated with Streptococcus. And PANS stands for Pediatric Acute Onset Neuropsychiatric Syndrome. Dr. Jill Crista is a naturopathic doctor and the author of the best selling book, Break the Mold. She offers several popular physician training programs on both Mold and also on PANS and PANDAS, as well as a course for patients on mold. Dr. Crista is now focused on research, teaching and writing, specializing in mold sickness, brain injury, and PANS and PANDAS. Thank you so much for joining us, Dr. Crista.
Dr. Crista: Thank you for having me. It’s great to be back.
Dr. Weitz: Thanks. So how did you become interested in studying PANS and PANDAS?
Dr. Crista: I’m a mom of twins with PANS.
Dr. Weitz: Oh, okay.
Dr. Crista: Yeah. In the trenches, that was before it even had a diagnostic name. My kids are 24 now, so this is, 20 years ago. Oh goodness, what’s going on and how do I help them? So I’ve been in the trenches and then thankfully my kids seemed pretty normal, with all that they had going on. They still went to school, played sports, all those things. And and you get known as the person who helped them. Her own kids do that. Then it’s oh let’s have you, every special kid, then come see Dr. Jill. I got a chance to see a lot of kids with different neurological things going on and autoimmune diseases and things like that. That’s how I got into it. And the tie between mold and PANDAS and PANS is that in many of the cases that I was seeing, mold was the trigger for the development of PANS.
Dr. Weitz: And it’s there’s certainly just seems to be a plethora of kids with psychiatric conditions these days. Anxiety seems to be everywhere. ADHD, difficulty concentrating, learning, there’s so many kids with psychiatric conditions. And it’s fascinating to consider that these psychiatric conditions may actually be caused by physical things happening in their bodies, rather than just this being a mood or emotional disorder.
Dr. Crista: PANDAS and PANS have really, and COVID actually helped us with that as well, this paradigm change in mental health, that it’s not just wrong thinking, there’s actually something physically going on in the body affecting behavior.
Dr. Weitz: Some of the most common signs and symptoms of PANS and PANDAS are all these emotional things. And how do we how do we wrap our heads around figuring out, how do we decide, how do we figure out what are some of the underlying causes? And I understand from your book that some of the underlying causes are mold, as you just mentioned, streptococcus, these other underlying infections, possibly toxins. How do we go through trying to figure this out?
Dr. Crista: There’s the art of medicine, right?
Dr. Weitz: Exactly.
Dr. Crista: If you have a child who develops anxiety, separation anxiety, OCD, tics we often see urinary sensitivity. So urinary frequency, generalized abdominal pain. There’s a confluence of symptoms. There are different clinical criteria for each condition, but anxiety is the one that is in pretty much 100 percent of the kids. There’s some level of anxiety. And what’s interesting is I see that with mold as well. Mold exposure there’s I don’t know that I’ve seen a mold sick patient that didn’t have some level of anxiousness that’s been ramped up. So if there’s that acute onset, and now acute could be a mild case coming on suddenly. So it may not be picked up the first time at the onset, but then with recurrences and flares, you get this, exaggeration of the behaviors that were happening before with, not wanting to leave a parent, not wanting to leave their room. Maybe we see some aggression or irritability. We might see some inability to write the way that they could. So they’ll start to drift across the page. So there’s all these little signs and symptoms. If we can catch the moment when it happened, and a lot of times that’s going back in time, family’s going back and saying, before it was really, really bad, it was bad, four months before that, remember when he couldn’t stop washing his hands all the time.
And we thought he was finally getting it and being clean. And instead that was actually the first onset. It was acute overnight, but it might’ve been mild. When we go back and we find, where was the time when the child’s behavior really changed? What was the fun? There was a fundamental difference or a behavior change, or maybe again, clinginess to one parent. They didn’t want to leave the parent or they’d cry. Or they might act out with anger ’cause they’re, that’s a real need for them. What was going on before that? So in that three month period of time, before that happened, did you move to a new house? Did they start at a new school? Did they go to summer camp? All those could be mold exposures. Did you get a new lawn ’cause you just moved into a new house or something like that and sprayed it with a bunch of chemicals? And make sure it was, looking like carpet and not like regular lawns. So the weed killers and the herbicides are the number one bad guy environmental toxin in these conditions. And I can talk about why that is, but look back about three to four months before that moment. And that really tells us a lot about what was going on. And the people that are doing more functional medicine, like you and I that are treating these kids. We are expanding the triggers beyond just infection.
So if you look in kind of the, in the conventional model, the focus on what’s the bug? What’s the bug? What’s the bug? Let’s make sure we take care of the bug. And that’s important because if the child has environmental toxin exposure, that has wrecked their gut microbiome, which is where our immune system lives, Then, 70 percent of our immune system is from our gut health.[00:07:00] If we are, they’ve just been chemicalized, talking chemicals or mold other things like EMS and mercury, if they’ve just had a dental appointment and they got a bunch of fillings or even one filling, if they’re a sensitive kid to mercury, that toxin exposure now has set the stage for the infection to just trip the last trigger. So the infection is important to, manage it and keep the load down on the kid, but that’s not the whole story. The whole story is how did that kid get a regular old infection that other kids get and have an autoimmune disease start? So there’s the question. Yeah. So I think looking at time helps.
Dr. Weitz: Now, does it have to be acute onset? What’s the importance of acute onset?
Dr. Crista: Yeah. This is a debated subject.
Dr. Weitz: I mean, cause we know most of these infections are low grade chronic things. And a lot of times we see even in mold, it seems to be a slow developing chronic thing.
Dr. Crista: [00:08:00] Yeah. So by the clinical criteria, yes, it needs to be acute. Where it gets a little wiggly is if it was acute and mild, then we can miss it. Usually, the classic story, the classic case is, the kid gets Strep, three weeks later, they change overnight, and they have tics, OCD, they can’t leave their parent, they have the anxiety, they have, all of a sudden this is a different kid. And that can be anywhere from right after the infection, during the infection, usually not during because usually it’s like a secondary response, but it can be up to three to maybe even six months after that infection to fit the clinical criteria that you have a kid that just overnight changes, the parents will say, I feel like our kid was just like a body snatchers, they came and they took it and they put a monster inside of my kit instead.
And it’s very scary. And these kids can get extremely scary, sick, they can start to feel like maybe their parent [00:09:00] is an imposter. So they get afraid of their parent, one parent and clingy to the other, so there’s a lot of, the brain just doesn’t work right when it’s so that’s the classic picture.
However, and I talk about this in my book on the definition of PANS, the reason that we even created a second thing from PANDAS is they found out that, wow, not all of these cases that are classic had strep. Some of them got the flu. A lot of them. Flu is a big triggering infection for kids. Also Mycoplasma Pneumonia, Chlamydia Pneumonia.
Mycoplasma is a lot like strep that it can go, it can evade the immune system and can be persistent for a long time. So that’s a, that’s like a, and it loves the brain. So it’s a classic other bacteria that can happen. And then we can see things like so then they were like, okay not everybody has strep, so we’ll create this other condition called PANS.
So it still has the acute onset. It can be an older [00:10:00] kid. It doesn’t have this like tighter age requirement as long as it’s a pediatric, before they become an adult at 18. If it was onset during that, it might be onset in a teenager for mono. So they had to open it up and I’m hoping we’ll open it up one more time for the congenital infection because that’s where it gets a little squishy.
These are kids who never really developed a totally healthy immune system. And that’s where my kids fit. I gave, I gave ’em a great sense of humor, but I also gave them Lyme and Bartonella . So I had that low ly and didn’t know it. I was diagnosed with quote fibromyalgia. It was chronic Lyme disease, and I gave that to my kids, which reactivated when I was pregnant.
Dr. Weitz: Now, how can you give Lyme disease to your kids? Is it that the ticks actually spread or is that somehow their immune system changes?
Dr. Crista: Because I had it in my bloodstream when I was pregnant and it crosses the placenta.
Dr. Weitz: Okay. Okay.
Dr. Crista: So they literally get Lyme disease. Okay.
Dr. Weitz: And Babesia
Dr. Crista: and Bartonella do the same. [00:11:00] So it’s a vertical transfer, it’s what we call it in medicine. But basically it’s like mom had it, it could cross placenta, it could infect baby. And we know this as, we know Lyme’s, some of the things that Lyme does is it reduces immunity, and it’s a neurotoxin, so it changes the neurology. So it’s a perfect setup for Pandas and Pans, which is an autoimmune disease attacking the nervous system.
Dr. Weitz: So those of us who like data, is there data to show that Lyme can be spread to children?
Dr. Crista: We have animal studies. We have a dog study that Dr. Charles Ray Jones, who I trained with in my Lyme training when we give a mom dog infected tick bite most, but not all the pups develop Lyme disease when they’re born or test positive for it when they’re born. And the cord blood is also positive. So that’s a way that we, those of us that treat. People with Lyme who want to get pregnant, cause they’re, they had Lyme, they feel [00:12:00] healed, but pregnancy can be such a stress on the body that you can have a reactivation just like what I did. I had it under control, and then, a twin pregnancy was enough to stress it out. So there is data in animals that show that there’s this vertical transfer is very possible and probable, we could say, because most not, but not all the pups got it.
Dr. Weitz: And then when it comes to infections, a lot of these, especially the viruses, tend to sit in your body and are already there, and then you get another infection that a lot of times will reactivate one of these latent infections. Things like strep, a certain amount of strep is present in our system all the time, but then can be activated or grow to a point where it creates symptoms.
Dr. Crista: And that’s the mold connection. So mold mycotoxins deplete our immune system of all of our respiratory passages. So our sinuses, our lungs, our gut too. But what can happen then [00:13:00] is we, if we don’t have enough immunity on those respiratory passages. The boss of the airways, which is strep, can then colonize, and that can become a fungal colonization if you’re exposed to mold spores in a moldy environment, and it can colonize with your own respiratory flora, so we get, basically, I think about our sinuses, our gut our mouth, everything has its own unique microbiome, and that is a healthy, sharing commensal community.
Everybody’s working together, working for the good of the whole kind of thing. But when you get exposed to mycotoxins, that starts to shift. So those commensal species, so all of these good flora that’s supposed to be there to protect us, which is primarily strep, by the way, they’re not all pathogenic types of strep.
Most of the strep in our respiratory passages are protecting us. But there are pathogenic strep that as you’re exposed to mycotoxins and you start to get that flora shift to having to act [00:14:00] defensively instead of communally and then over time that defensive activity is harming themselves and their neighbors and that allows more non commensal or what we’d say pathogenic species to be hosted in those passages.
And then you are dealing with antimicrobials, antibiotics, antifungals, to try to get that system back and, back in balance and have the commensal species take over again.
Dr. Weitz: Interesting. I want to go down a side rabbit hole just for a minute here and not get too off track. But How I’ve always tried to figure out, I don’t understand, but somehow I know they’re related. They mold ends up increasing Candida. And I know that they’re both fungi, but mold is a different thing than Candida, but somehow you’re treating a patient with mold and they end up having this increased Candida that you have to deal with also.
Dr. Crista: a lot of times. So not [00:15:00] everyone with Candida has mold illness or mold exposure because you can get it from, a course of antibiotics or junky diet or those kinds of things. But a lot of people with mold exposure have Candida overgrow. And so what the mycotoxins are, let’s talk about what they are. So when mold is in an environment, it’s making mycotoxins to compete for territory. And what mycotoxins are poisons that are meant to harm other living things. And they are meant to allow the mold to creep its territory.
So really the mycotoxin message is, I’m trying to move in, mold’s trying to move in. And so when we have mycotoxins in our gut lining, what mold’s moving in means is it is laying a red carpet for the fungal species to survive. And so it’s doing things like immune depletion, it’s reducing gut motility, it’s changing the kinds of nutrients that your microbiome [00:16:00] craves to become a carb craver versus a protein craver.
And so it’s just like laying the red carpet and saying, here we go. And then all the other fungi are like, yes, we’re going to take over this, and that’s how they, that’s how they work together. They compete, but they also work together in that way.
Dr. Weitz: Just for a second. I have to go down another slight rabbit hole. I can’t help it, but what’s becoming really popular in, in the United States right now are medications to deal with obesity that work by slowing gut motility. And you were just talking about the problems with gut motility. And I treat a lot of patients with gut problems and motility is a huge problem. And now millions of people, and this is even being recommended for kids, are taking these GLP 1 agonists. And I know some people have had wonderful benefits in weight loss, but it works by [00:17:00] slowing gut motility. And what plethora of problems are we asking for by doing this?
Dr. Crista: Probably in someone who is healthy, not much. And I’m a huge fan of those for the right purposes used at a naturopathic dose. Not the big old doses that we would do for diabetes, but and actually my friend, Dr. Tina Moore, she’s taught me a ton about this and is a great resource for that. But in a normal person, that’s probably not doing much because it’s changing the motility globally. So from the top down, so we’re not picking and choosing areas of motility changes like we see with certain kinds of neurotoxins like Lyme. like mold EMFs can change the calcium potential in a tissue and can change the motility. It can change neural function, all those kinds of things.
Dr. Weitz: SIBO is often caused by motility problems.
Dr. Crista: Yep. SIBO is a motility disease, not an infection disease. If it’s motility first, infection [00:18:00] is the result.
Dr. Weitz: And that’s the first thing I think about when I think about patients who are, affecting their motility.
Dr. Crista: Yeah, I know I do wonder, I think slowing is different than reversing, SIBO, one of the main causes of that is someone having food poisoning and vomiting, so things, come up in a very violent way and then because we have the wrong species, the right species in the wrong place, That can affect the neurological system of that area.
And then you get focal or targeted neurological problems. And then in mold, in the cases of mold with mycotoxins. We can get these little focal areas as well, wherever there’s a concentrated lymphatic pack pocket. So you can get these kinds of spotty gastroparesis things that can have, or motility issues, gastro is technically stomach, but you can see these focal areas, of course, global, you can get top down.
But I think that, yeah, if you have had mold exposure, if you’re dealing with any kind of neurotoxin illness, if you have chronic constipation and you [00:19:00] can also have diarrhea, SIBOs, Diarrhea is the, reaction to that to try to clear them out. That’s a healthy reaction, but if it’s gone on long enough, then you get this like alternating constipation, diarrhea. I, I think you’re being really wise to say, Hey, maybe this isn’t the right thing for you because we could be making the problem worse.
Dr. Weitz: So let’s go into testing for PANS and PANDAS.
Dr. Crista: First message is these are clinical diagnoses, which means they can be diagnosed and treated without having to have a positive lab test. That’s a really important thing for parents to know and practitioners, because I will see practitioners be worried about using some of the medications we need to use. Some of these kids that get real sick, We need to put them on long term prophylactic antibiotics, because strep becomes their kryptonite, it’s just
Dr. Weitz: And it can be hard to justify that without having data.
Dr. Crista: Without [00:20:00] having the data, I know, yeah. But right now, because it is such a new burgeoning condition, and newly recognized, it’s been around a while, but it’s newly recognized. And also on the rise, because we have things like covid, we have so much more environmental toxicity. So these are on the rise that when I first started and 20 years ago I think it was estimated that maybe one in 500 kids, one, one in 500 to a thousand, and now the estimate is anywhere up to one in 200 kids are gonna develop these conditions. So that’s a ton of kids and that means it has been on the rise in a exponential way over the last 20 years. And now I completely lost your question.
Dr. Weitz: Oh, about testing. Oh, testing.
Dr. Crista: Okay. Thank you. So we don’t have the data yet to know exactly what’s the mechanism and is the mechanism different between the two conditions. And like I was talking about with the congenital, we need a third category, so we have Pandas, [00:21:00] PANS, and we need plans, like pediatric long name associated, something like that. We need one, a third one. So we’re lumping these congenital ones into the PANS people so that we can administer treatment that’s effective for them.
But yeah it’s tricky because what tests do you do if we don’t know exactly what’s the target? So we know some targets. We know that the dopamine receptors in the brain, which is in the basal ganglia, get destroyed. We are assuming that’s an autoimmune. So the body attacking itself, that’s their, that’s why pediatric autoimmune neuropsych syndrome disorder associated with strep.
Dr. Weitz: Is there a way that clinicians can determine that?
Dr. Crista: By clinical symptoms. So yeah, once, that’s the thing is we’ve gone, we haven’t gotten from research to clinical completely. There is something called the Cunningham Panel that catches PANS pretty well. And that looks at some of those autoimmune targets against basal [00:22:00] ganglia and gangliosides and some of the things that are in the brain.
You
Dr. Weitz: can Which lab offers the Cunningham Panel?
Dr. Crista: That’s Molecular Labs.
Dr. Weitz: Okay.
Dr. Crista: Yeah, but just know that if you have a PANS or a uncategorized congenital, you may have a kind of normal looking Cunningham panel and they still have a condition.
Dr. Weitz: Okay.
Dr. Crista: That’s a nice test for when you have a PANDAS case where strep was the infection, then you have an acute overnight change in the kid. I’m finding that the Cunningham panel is really nice for that. And it’s a nice piece of paper. It’s yes, there’s, this is an actual physical thing happening in your kid’s brain. It’s not just bad behavior. You’re not a bad parent, just Just, it’s okay, this is physical however, just know that can miss some of them, and so that’s the problem is that the newer research is showing that there’s also destruction of the cholinergic interneurons, meaning things that use acetylcholine, which is runs our autonomic nervous [00:23:00] system. Those neurons, those inter neurons that are going to be telling one, one nerve to talk to the other using acetylcholine, those are having destruction as well. Yeah. And that’s why I like to use the herbs that I use because they address all of it.
Dr. Weitz: So what kinds of panels do you recommend for us to do, or should we just go right into treatment?
Dr. Crista: Again,
Dr. Weitz: the
Dr. Crista: clinical diagnosis is key. So you can feel like, okay, if there are, the child is meeting these major criteria there are certain criteria that need to be met. Some are major, some are minor, and then you can diagnose them and you can feel very comfortable treating them based on that.
That is that’s the standard of care is that we’re using clinical diagnoses. And those clinical criteria, just be really that, then you do need the acute part of it, the acute onset part of it. So yes, Cunningham panel can help to answer the question. Point more arrows. There’s also some of the things like Vibrant has a neural zoomer [00:24:00] that you can look to see, is there a blood brain barrier breakdown?
That gives me a little more hint that we’ve got to really focus on the gut, because if the gut’s leaky, the brain’s going to be leaky. And then Cyrex Labs has some really nice arrays. Their Array 7 is great Array 20, so we can look at some of the correlations of Again, blood brain barrier breakdown.
What are there any auto antibodies being made, meaning antibodies to the brain? So that can give you a picture if you are dealing with families that need paper proof, and that’s very helpful. And that’s only telling you like, yeah, this is probably pandas or pan, but it’s not telling you why did we get there?
And then if they’re a kid who needs psychotropic medication, I highly recommend. the gene site test where we pre test their genetics for processing those medications. Because most of these kids have blood brain barrier leakage and because psychotropic medications are designed with chemicals [00:25:00] to open up the brain so that you can get the medication up there.
So when you administer psychotropic medications, you’re causing blood brain barrier leakage on purpose. We know that’s what these drugs do. So if you have someone who already has an open brain and you’re giving them psychotropic medication that opens it farther, they’re going to be acutely sensitive to a regular dose.
So if they need psychotropic medication, what I will do to start is test their gene site to make sure they’re not a speedy or a slow metabolizer of that drug and know that I’m going to open up their brain like a sieve when I give these medication. So I started an eighth, sometimes even a 16th of the normal dose, and you’ll need compounding for that.
Dr. Weitz: Okay. So. Let’s what about if you’re suspecting Lyme? Do you do a Lyme panel?
Dr. Crista: That’s also a clinical diagnosis.
Dr. Weitz: Okay.
Dr. Crista: Yeah, and congenital Lyme won’t necessarily look the same as a classic Lyme. They’re not going to have, the blown up joints, but they have joints that are, that tend to injure very easily and they [00:26:00] take a long time to heal.
So a kid that’s just their ankle is out, now their knee is out, now their shoulder feels popping, those kinds of things. Like it, it doesn’t look like a classic Lyme case if it’s congenital. He found some core things in kids who were born with Lyme and had, had Lyme through congenital exposure.
And atonia was one of those. What does that mean? That means low or no autonomic tone. And these will be the kids that they’re the natural tone. If you’re out, if your autonomic system is toned, normally you will have your shoulders higher. Like I have You can probably even see them and people who are listening are like, what is she talking about?
Like my shoulders go down because I have dysautonomia. So if you have a normal autonomic system, you’re going to have a higher tone. You can hold your posture up better. So you’ll see that atonia, there’s just that little bit of drop in the shoulders. A lot of times you can look at like how far do their hands go down their [00:27:00] legs.
If it’s longer than, I think there’s measurements that we can do, but that’s because their body is not holding those shoulders up. And so the arms can drop down. So as a chiropractor, that’s an easy thing that you can test and see, okay, did they look like they have longer arms than they should?
That’s because they’re not holding the tone. They don’t hold chiropractic adjustments well. So these are kids that you adjust them and then the body doesn’t adjust to the adjustment, so to speak. There was one other thing. Oh, and then you can tell if they also have vagus nerve involvement, if you have them open their mouth, stick out their tongue and go ah, and try and go, Oh, like that a little higher, their uvula will go off to the side and that they have some vagal nerve.
So something’s going on in the autonomic system that we can take a look. If they have, those are little teeny, tiny signs. It’s this might’ve been a congenital. And then you look at mom, you check out her history, if there’s any, history of Lyme, history of fibromyalgia, those kinds of things, then we have a kid that may need to be treated for [00:28:00] Lyme.
Dr. Weitz: Okay, so let’s go into treatment.
Dr. Crista: Oh, I had one more thing.
Dr. Weitz: Oh, yeah.
Dr. Crista: If there’s Lyme Borrelia, which is the way that they move through the body, they corkscrew through tissues, and kids will have tics that have a twisty or corkscrew nature to them when they have that. When they have sinus colonization, they will have a lot of eye blinking as part of their tics because their body is, or they might even hum their tonsils have turned into just mush. And they’re hosting a lot of things. They will have a hum because they’re trying to increase the nitric oxide on the surface and kill the bug. So by the, we can watch what the ticks are doing to tell us where the kid needs support.
Dr. Weitz: Do you swab the nose and test for strep?
Dr. Crista: Yeah, I test for everything.
Dr. Weitz: Okay. Most people don’t realize that the nasal cavity is this direct route into the brain.
Dr. Crista: Yes. I show, I [00:29:00] created a couple of images in my book for that very reason to show that strep throat also becomes strep nose. So what happens is when you get strep throat, the body will send messengers down to the lymph nodes in your neck, and then it’ll make antibodies. And then those antibodies get sent to the throat, but also up to the nose. Cause the body’s duh, it’s our breathing zone. Of course our nose is going to have problems if the throat has problems, But when those antibodies get up there, we know from mouse studies, when they put strep on the nose of mice, those antibodies will migrate back to the basal ganglia, to the brainstem. And that’s what’s running our whole background autonomic system. And then they see that they will start to make antibodies to that own tissue just by getting repeat exposure to their nose. The great study out of Columbia. Yeah.
Dr. Weitz: Oh, wow. Fascinating. It’s
Dr. Crista: not, it’s not the strep getting in the nose.
Dr. Weitz: It’s the
Dr. Crista: antibodies, which means every time you have strep throat, you could be getting destruction of the central part of the brain. [00:30:00]
Dr. Weitz: You wonder what role this can play in development of dementia when they get older? Because you were talking about deteriorating of handwriting, and that’s one of the characteristic things with patients with Alzheimer’s.
Dr. Crista: I think there’s a high correlate, high possibility of correlation with Parkinson’s. And Early Onset Panda’s Pans, because of the basal ganglia distraction. And then we
Dr. Weitz: also know about the research that’s been done about how amyloid plaque builds up to protect the brain from infection. So you’re getting these antibodies into the brain and then, it’s probably setting up an increased risk of this amyloid plaque building up to protect the brain.
Dr. Crista: And then, and yeah, I think Dr. Dale Bredesen was the first one that said, amyloid plaques are really good mycotoxin sponges.
Dr. Weitz: It’s interesting. There’s almost this symmetry between childhood and old age. And you start out in diapers and you end up in diapers. So [00:31:00] let’s go into treatment. You have this really organized system of understanding how to set up a treatment protocol. It’s fairly complex, but it’s very well organized.
Dr. Crista: Thank you. Yeah. These are families in chaos. So I tried to be as. Organized as possible. So it’s there’s a step one, there’s a step two, here are the tools and here’s how you match it to the kid, yeah. So I came up with I put in the book core four, I wanted to put core 10, but I didn’t want to overwhelm anybody. So I made five, six, seven, eight, nine, 10 is all part three in the book of this is how you actually do recovery. And the core four is how you do rescue. So that’s the, let’s get out of crisis mode.
And then when you’re out of crisis mode, please go to part three. That’s how you get out of this finally, and keep your kid not so flareable. We see flares happen about every three months and that’s the tricky part with treatment is then. You start [00:32:00] administering treatment, the child might be really getting better with that and you can be high fiving yourself and it’s only because that was the course of the disease it was going to calm down anyway.
Y’all, you also might give some treatment and they flare a little bit and you think, did we do that? Did we push the body too hard? And it was just going to be that they were going to take a, you A turn, an increase in symptoms anyway, so you, this is a long game, I guess is what I’m trying to say.
Dr. Weitz: Patients and clinicians need to understand that this is going to be treated over a period of potentially years, right?
Dr. Crista: Years, usually yeah. Okay. And that’s how I wrote the book. I wanted parents to have tools in hand. And so they can be working with their practitioner and they know what to do in the, in between they know what to do between appointments and maybe even to, save appointments in general.
So I have the core for the first core is tame the flame. The second is beat the bugs. The third is regulate immunity. And the fourth is guard the gate. And that’s the rescue plan, so tame the flame has to do with all neuroinflammation. So neuroinflammation means inflammation in the nervous system.[00:33:00]
In these cases, primarily it’s in the central nervous system, like we were talking about deep in the brain. So we’re trying to take things that are going to calm down the neuroinflammation and paying attention to the trigger. So if we’re only focused on a bug, we might just deal with the inflammation you could handle with Advil.
But it isn’t only that inflammation, because they have environmental exposures that set the stage. So we know that there’s going to be mast cell involvement. We know there’s going to be specific types of inflammation we can adjust. And we know where it’s going to be. It’s going to be primarily in the central nervous system.
So that’s why I like to use things like Resolvins. These are the most anti inflammatory aspect of fish oil, so they’re extracted out from fish oil.
Dr. Weitz: Also known as like SPMs.
Dr. Crista: Yes, yeah, SPMs, Special Pro Resolving Mediators. They are, they can go into the brain tissue, and they can reduce inflammation. So they’re fat soluble, and that’s one of the reasons I put that as the first thing, because We know the type of [00:34:00] inflammation those are going to deal with. We know if we extract that out of the fish oil, even people who have histamine responses to whole fish oil can tolerate the, these extracted aspects. They don’t get a histamine flush from them.
Dr. Weitz: What do you think about patients who have fish allergies?
Dr. Crista: Yeah, they can’t take it, unfortunately.
Dr. Weitz: Okay.
Dr. Crista: Yeah, I know. That’s the bummer. And that’s why I put other tools because it’s that’s not the only one, we can get at it a different way. Another nice fat soluble thing that tames the flame is PEA, which is not the food pee, but palmitoylethanolamide. And it’s basically this thing that we make in our brain naturally to reduce inflammation.
But if you have an attack on the brain. You will plow through that. So that’s a way to get that that nutrient, we could say anti inflammatory nutrient back in the brain where it belongs. And that’s another fat soluble one. So if I have somebody who’s fish allergic, then we’ll go heavy on the PEA [00:35:00] instead.
Dr. Weitz: Okay. And then fever few, which I usually think of something for headaches.
Dr. Crista: Yes. The parthenolides in fever few are amazing. They are hitting the type of inflammation that we get with these autoimmune attacks. And I cannot tell you, I have emails that I get that I’m just in tears reading that a family will say, our kid’s been sick for four years, won’t come out of the bedroom, has stopped reading, can’t go to school, obviously, this is a kid who’s losing their childhood.
They started the child on fever cue only. And then they like, they’re like, okay they didn’t react too bad. So we’ll add resolvents. So it was fever cue and resolvents. And the resolvence wasn’t even till the tail end. And in two weeks, the child was out of the room reading chapter books to the parents and it completely transformed the child.
So brains are inflamed and we have so many tools to help them with that.
Dr. Weitz: And then under flame the teams, you have these other categories. So you [00:36:00] have the
Dr. Crista: The mast cell managers, right? Yeah, because there’s different kinds of flame. So again, if it was just Advil, and sometimes kids are sick, we will go for the ibuprofen.
Absolutely. A two week trial of ibuprofen as a clinician. That is a wonderful test because if that changes the child’s behavior, you probably have a panda’s pants get on your hand. So just a two week trial of ibuprofen, a nice high dose like 10 mg per kg kind of thing. So it’s more of a pharmaceutical dose and you got to warn families, if you do that, there’s a risk of GI bleeds.
There’s a risk of bleeding in general, there’s Kidney things that can show for
Dr. Weitz: a hundred pound kid. You’re talking about 2000 milligrams is it
Dr. Crista: throughout the day?
Dr. Weitz: Yeah. Okay.
Dr. Crista: Yeah. And then I always do that with BPC one 57 so we can protect the gut lining. Okay. Tolerate it. You do it.
Functionally, right? It’s a very helpful drug. And there’s these other things that we want to make sure and [00:37:00] protect the tummy lining, but just to, you don’t do that forever, but that’s a wonderful drug trial to see if there’s a profound change. And you can see a kid who’s ticking, who can’t sleep.
Maybe they haven’t slept for two days. This, these are all the things that we can see from the autoimmune destruction of the basal ganglia. Why is that? That’s because. Those receptors receive dopamine and dopamine can transfer into glutamate really easily. And those are excitatory brain chemicals.
So is acetylcholine. So those cholinergic interneurons, when they get destroyed, acetylcholine doesn’t have anywhere to go. So the kids are, their brains are swimming, drowning in these excitatory brain chemicals. And that’s why the tics and that’s why the OCD, it’s like There’s all this energy with nowhere to go, and that’ll cause, in a lot of cases, it can cause insomnia, too.
Dr. Weitz: Okay. You have Perilla, which is an interesting one. We’ve used that [00:38:00] for allergies.
Dr. Crista: Yes. Yeah, and allergies are mass, so meaty,
Dr. Weitz: you
Dr. Crista: know?
Dr. Weitz: Have you tried that product with the quail eggs from Integrative?
Dr. Crista: Yeah, I haven’t seen huge differences. I know some people say it’s a game changer, but I think for my patient base, we’re also talking about dietary things typically.
Dr. Weitz: Okay.
Dr. Crista: However, with pandas and pans, one of the symptoms can be restricted eating. And so we want to be really careful not to add to that problem. My only. 100 percent like diet advice is organic and everything else is on the table, because if you have a kid who’s restricting food, we don’t need to take away anything.
Now, are there perfect things we could add? Yes, we could do a histamine free diet. A lot of kids with mold exposure have high oxalates. We can, reduce their oxalate load. But histamine is usually the one that does it. makes the big difference in the kid because of the mast cells going into the brain, [00:39:00] spill, spilling histamine.
A lot of times we can make a big dent there.
Dr. Weitz: That’s why I said a glyphosate. Do you take away gluten?
Dr. Crista: I don’t, because again, the restricted eating thing, just say, take the pressure off yourself. These are parents who, a kid isn’t sleeping for two days. Okay. They can’t, the parent can’t even take a shower without the kid. Cause the kid has. Separation Anxiety they might be aggressive, so they have to protect the other people in the family, so things can get really off the rails.
Dr. Weitz: Okay. And,
Dr. Crista: With Glyphosate, and not just Glyphosate, but Atrazine causes a change in the dopamine receptors in the brain any kind of herbicides, pesticides. If you’re doing organic, those are out and then you’ve reduced the, that exposure for the kid and we can try to recoup some of the gut microbiome so we can get their immunity back again.
Dr. Weitz: Okay. And then you have to beat the bugs.
Dr. Crista: Beat the bugs. So the bugs are a problem. What got the kid here, like I said, was this pre [00:40:00] state, this antecedent state that they had immune depletion.
That’s where the environmental toxins really come in, but then there’s a bug, so there is, there’s been a few cases where we, a kid had an acute glyphosate toxicity, like played on a soccer field. I have one case where played a soccer day, a whole tournament day, and they had just sprayed that morning and they didn’t tell anybody.
So they had just sprayed everything and the kid developed PANS. We couldn’t track any other infection. So in a few cases, it’s environmental only. But in the majority of cases, then there’s an infection that challenges the child’s immune system and the immune system just wasn’t up for it. So we do need to beat back those bugs and get things back in balance.
Dr. Weitz: And so the first category you have is these botanical avatars and you have Chinese skullcap as one of your favorites.
Dr. Crista: Yes. Botanical avatars, I name them that because an avatar means an ideal. And so when we look at all of the mechanisms that go into this condition, the immune [00:41:00] depleted state. The brain chemistry changes, what happens with the receptors themselves if they’re food restricting, low blood sugar, we’re looking at all of the things, gut microbiome, and when we look at the whole picture, these avatars in this section were perfectly made for these conditions.
You could use that one plant and that one plant only and make a big dent. So for me, once we get the kid out of flame, then the avatar becomes the foundation at the base of everything that we do. So an avatar stays with them their whole treatment period, and then we plunk the other things on top of that.
So Chinese skullcap is wonderful because it’s great for mycoplasma pneumonia, which is a really hard bug to get at. Also for strep and it has all the other things, the brain chemistry balancing, the gut microbiome. And we see that things like that, Oregon grape root, they have antibiotic activity, but people are like, okay, [00:42:00] so does that mean it’s going to wreck the gut?
It turns out that those two plants actually increase the butyrate, which is the favorite food of our commensal, of our favored microbiome in our gut. So the plants don’t act the same way. in their antimicrobial property as a drug does.
Dr. Weitz: Oregon grape is basically berberine. Is that the main ingredient?
Dr. Crista: Yeah. But the whole plant is what changed the butyrate, not just the berberine. The berberine.
Dr. Weitz: Interesting.
Dr. Crista: If you’re just going for the berberine, you’re going to miss the activity that we’re looking for pandas and Pam.
Dr. Weitz: You also have got a cola, which I always think of as a blood sugar thing.
Dr. Crista: Yeah interestingly enough, gotu kola, we can give this it crosses the blood brain barrier within 5 to 15 minutes of taking it. And it’s a really nice tea. It doesn’t, it’s one of those things that kids will actually drink. You can add a little honey and you can get it down because it doesn’t taste like much. It just is like a musky green [00:43:00] flavor. But it crosses the blood brain barrier in 5 to 15 minutes and it will protect the microglia, which are the naughty little monkeys in the mind that do all this destruction. It will calm them down so that when a child eats, if they get any increase in gut endotoxins. it won’t agitate the brain and induce attack. So part of the food restricting is that when kids eat, they will get this increase in endotoxin and it starts to increase the attack on their own tissue. So the body wisely says, stop eating. We can’t do this. And, but unfortunately then kids can get very underweight. That go to Cola can be done ahead of time. You can give ahead of time before meals. And it’ll protect the microglia monkeys and keep them calm. Interesting. Yeah.
Dr. Weitz: Cool.
Dr. Crista: Amazing. Like we have so many tools. So cool.
Dr. Weitz: And then antimicrobials. So things like oregano, thyme. [00:44:00]
Dr. Crista: Just depends on what critter you’re trying to whack back. And that’s the clinical discernment. You as a doctor, are you dealing with a kid with Lyme? Probably need to get some cryptolepis and Japanese knotweed. You’re dealing with a kid with parasites. These kids can get really wormy because they don’t have the gut immunity like most of us. There’s a lot of hypogammaglobulinemia in these kids. That was why they got Panda’s Pans. So they can tend to take on parasites. So I use a lot of black walnut with them and a lot, you just treat them like, treat them aggressively and they need the help,
Dr. Weitz: or
Dr. Crista: fungi, we need that omega 9 time.
Dr. Weitz: And you also talk about making a steam out of some of these herbs and getting it into the nose that way.
Dr. Crista: Yeah, that’s in the Guard the Gates because we do need to, their defenses are down. These are kids whose defenses are down. And just a simple steam inhalation can be both calming to the child and it’ll also, it calms them from a few things because those [00:45:00] volatile oils are also acting as an aromatherapy. When we steam some of these plants that we know, we all know and love and we’re familiar with, like kitchen herbs. Sage in particular, and thyme, you can steam them. Those volatile oils have more antimicrobial property than eating the plant itself. So once we steam it, something magical happens. and steam can reach every part of the sinus cavity. So a nose spray only goes so far, but a steam you can get everywhere and you can get into the lung tissue as well. There’s some research showing that a change in the lung microbiome can affect the brain as well. It’ll agitate the microglia monkeys in the brain. So a steam is getting all of that taken care of. So we have the effect of the volatile oils on the bugs themselves. but also on the brain chemistry aromatherapy effect.
Dr. Weitz: And then we have to regulate immunity.
Dr. Crista: Regulating immunity is [00:46:00] primarily the gut. We are more microbe than man, as they say, so if we did a cell to cell count of your bacteria in your gut and your cells of your muscles, bones, all that thing, we’d have more cells in our gut that belong to the other guys than our own tissue.
And if you did a DNA count, it would be the same. So there’s more DNA that belongs to the critters in our gut than our own DNA tissue. So they determine a lot. And when autoimmune disease. It’s the body attacking itself. Why would it do that? Why it’s supposed to attack us
Dr. Weitz: reactivity, right?
Dr. Crista: Because it’s lost discernment of what is self. And so if our definition of self is basically our gut microbiota, because there’s more of them than there are of us and we have anything that is destroying our gut microbiota. Now the immune system is let’s see what’s self. What’s not self. It loses that discernment.
So when we regulate immunity, focusing on the [00:47:00] gut, what we’re trying to do is build back the microbes, not just the bugs themselves, but by giving them the food that they like, like butyrate. It’s wonderful. It’s known as a nootropic, which means it helps with the brain healing itself. It also helps with the panda’s pan’s brain as well by calming down the gut microbes and not having them feel so at risk.
Dr. Weitz: But you might also feed the bad bugs too, right? With butyrate?
Dr. Crista: Not as much as you would think. So that’s why we have beat the bugs first. So sometimes you can add, if gliotoxin is a mycotoxin that’s high in a kid because they have fungal burden veering toward fungal infection, they can have high gliotoxin and things with sulfur like butyrate can help the mold if you do too much, if you don’t have the Antistep on board first.
Dr. Weitz: So that’s
Dr. Crista: step two. And then we can add the butyrate kind of free form.
Dr. Weitz: And then [00:48:00] probiotics is part of the mix as well?
Dr. Crista: Yeah, probiotics, peptides. Yep. Those are all things. And then regulated immunity. We didn’t really talk about what drugs fit in each of those, but that’s where IVIG would come in because some kids do need that.
We give IVIG at a very high dose and I want to tell everybody, I have a typo in my book. It’s very important. It’s 1. 5 to 2 grams per kilogram of IVIG, which is a suppressive dose. So we flood the body with IVIG. with immunoglobulins and we do it over and over again because we want the bone marrow to take a vacation and forget that it was upset about, that it wanted to make antibodies to its own tissue.
If you do the supportive dose of immunoglobulins, which is below one, up to one milligram or grams. See, I did it again. gram per kilogram of body weight. You can actually make it worse because you can fuel the autoimmune attack.
Dr. Weitz: Interesting. So this is intravenous immunoglobulins. [00:49:00]
Dr. Crista: Yeah, and usually my, depending on the severity of the kid, we might do that every four weeks, every six weeks, every eight weeks. The goal is to get them out of crisis, and then we stretch it out to see how long can we go before their immunoglobulins hit a trough again. We don’t want them to hit that trough because that, then can allow the autoimmune attack to happen.
Dr. Weitz: So that’s a strategy for acute flares.
Dr. Crista: To, for healing.
Dr. Weitz: Right.
Dr. Crista: For recovery.
Dr. Weitz: All right. And LDN, you use that as well sometimes?
Dr. Crista: Yep. I use it a lot.
Dr. Weitz: Oh, okay. Yeah. And you like certain peptides?
Dr. Crista: Yep. The BPC 157 the TB4 FRAG is, it’s basically thymicin. It’s from our thymus gland. And again, both of those go back to the pre immune depleted state situation.
So how do we get kids out of this? We nourish their immune system so that they can get [00:50:00] out of it.
Dr. Weitz: And both of these are oral peptides.
Dr. Crista: Yeah, they don’t have to be IV, peptides are very stable, so the capsules can be opened up, they go right through, they’re not broken down by the stomach acid, actually that’s, they’re the result of breaking down proteins in the stomach acid, so they’re like, yeah, they get the path.
Dr. Weitz: That’s cool.
Dr. Crista: Yeah.
Dr. Weitz: All right, good. Final thoughts about how to overcome pans and pandas?
Dr. Crista: Just know it’s the long game. And you’re not a bad parent. This is not behavior problems. This is a body problem. So if you’re not getting the support that you need with the doctor you’re working on, or if they’re not panned or pandas or pans literate, go find someone that is because you can do real damage. The longer this brain attack can happen in your kid, the more damage that’s happening in their brain. So because it’s not immune, get to it.
Dr. Weitz: And how does somebody find a practitioner who’s skilled in pants and pandas?
Dr. Crista: Right [00:51:00] now in the footer of my website, I have Mold Literate, Lime Literate, and PandasPans, so you can go there and get links.
There are a couple of organizations. There’s the Pandas Network and then there’s the Neuroimmune Foundation. And those are some areas that you can go find. I do any continuing ed than any of those have given all through time. And there are tons of amazing doctors that also attend those that can help.
Dr. Weitz: Cool. And how can listeners get ahold of you and find out about your programs?
Dr. Crista: They can come to drcrista. com. That’s D R C R I S T A. com. And I’m also on Instagram and, Facebook and all those things. YouTube.
Dr. Weitz: That’s great. Thank you so much, Dr. Crista.
Dr. Crista: Thank you.
Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings [00:52:00] and review. If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. Some of the areas I specialize in include helping patients with specific health issues like gut problems. neurodegenerative conditions, autoimmune diseases, cardiometabolic conditions, or for an executive health screen and to help you promote longevity. and take a deeper dive into some of those factors that can lead to chronic diseases along the way. Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310 395 3111 and we’ll set you up for a new consultation for functional medicine. And I look forward to speaking to everybody next week.
