In May, this article appeared in JAMA Psychiatry. The article is about the high incidence of anxiety disorders in children, and its authors are Kristy Benoit Allen, Ph.D., Margaret Benningfield, MD, and Jennifer Urbano Blackford, Ph.D. The article claims that at least 30 percent of children suffer from excessive anxiety, making it the most common mental disorder in children. They also note that those children with anxiety have a much higher incidence of other common brain disorders when they become adults. They then present a long list of factors likely contributing to this massive childhood anxiety epidemic. They conclude that the best treatments are a combination of cognitive-behavioral therapy (CBT) and low dose Zoloft. They also note that 50% of treated children will relapse within 4-12 years after treatment with this wonderful treatment approach. What they describe is a real mess. Let me attempt to clean up this mess. I sent off this email to the lead author telling my perspective on the problem:
Dr. Blackford:
I read your recent article in JAMA Psychiatry on anxiety with interest. From my perspective as a Family Physician with an interest in Neuroscience and 40+ years of clinical experience, you are making the problem more complicated than it needs to be. I always make common sense my guide. In past eras, kids had plenty of reasons to be anxious—lack of food and shelter, frequent exposure to dangerous predators, the early death of caregivers, frequent serious infections, and other common difficulties. Today’s kids don’t have to deal with any of these issues. Their lives certainly aren’t stress-free, but they are living in much safer environments. So, what the heck is going on? Let me explain.
As you likely know, Hudson and Pope from McLean proposed a new disease model in 2003 claiming that 14 common brain disorders are part of the same disease process. They called this new disease Affective Spectrum Disorder (ASD). Because it was such a radical idea, and they never found the disease’s triggers or pathology, ASD never made it out of academic medicine.
At the time, I was a country doctor—the only one in a town of 5,000 on the Iron Range in Northern Minnesota. During the onset of the obesity epidemic, I decided that I needed to study the topic. The first thing I learned was that obesity is defined as excess body fat. I wondered why the experts recommended BMI and weight, two parameters that tell you nothing about the amount of fat in your body. The NIH Consensus Report on Obesity recognized that obesity is defined by excessive body fat, but they went on to state that it’s too hard and expensive to measure body composition, so they bet the farm on BMI. BMI is a size measure, and I can tell your size by simply looking at you! I ignored their advice and purchased two technologies to accurately measure body composition (a Futrex 5000 machine using near-infrared light and a Tanita machine based on bioelectrical impedance.
Over the course of decades, I measured over 10,000 body composition readings. Because of my interest in Neuroscience, I also paid close attention to their brain dysfunction symptoms. Over time I noticed a very clear association between these symptoms and changes in body composition. It also seemed like the brain dysfunction symptoms would always precede changes in body composition. If symptoms increased, within weeks percent body fat would rise independent of caloric intake or exercise level. The opposite was confirmed when the symptoms decreased. Over time, I also figured out that this new disease’s most obvious primary trigger was the consumption of neurotoxic, highly processed food. I believe I saw the same condition first reported by Hudson and Pope. I decided to change the name to Carbohydrate Associated Reversible Brain syndrome or CARB syndrome. I have identified 22 symptoms of CARB syndrome, and most of them overlap with traditional brain disorders, creating a lot of diagnostic and therapeutic confusion.
As you can see, anxiety is one of these symptoms. The lead symptom of CARB syndrome is having excessive hunger and intense cravings for sweet and starchy food. If any of your anxious children have such cravings, they have CARB syndrome, not classic generalized anxiety disorder or panic disorder. The treatment for CARB syndrome is entirely different from classic generalized anxiety disorder or panic disorder. If you don’t understand the disease you are treating, you won’t have much success treating it.
Depression is another example. The Greeks first described major depression or melancholia. A depressed person lost interest in daily activities, family and friends, slept poorly, felt negative and down, and lost their appetite, and lost weight. Without these last two parameters, you couldn’t get a diagnosis of melancholia or major depression. In the 1970s and 1980s, we started to see many folks who appeared depressed, but they had an increased appetite and weight gain. The folks at DSM didn’t quite know what to do with this, so they decided to include both. If you look at DSM 5, you will see two subcategories of depression: “melancholia” or rare classic depression associated with loss of appetite and weight loss, and “atypical depression” associated with an increased appetite and weight gain. Most folks diagnosed with depression today have atypical depression.
Even a 7th-grade science student knows that if a parameter qualifies you for a diagnosis throughout the spectrum of the parameter (say appetite and weight), the parameter must be discarded because it can’t possibly help you to make a diagnosis.
When treated appropriately, both adults and children with CARB syndrome have markedly improved brain function (with less anxiety), and they slowly lose excessive body fat. I outline the diagnosis and treatment of CARB syndrome in my book “Brain Drain”:
I can send you a free Kindle copy if you are interested in reading it. Even though the CARB syndrome concept is a bit radical and new, it has gained some support from many top scientists and researchers, including Robb Wolf, Loren Cordain, David Perlmutter, Robert Lustig, Barry Sears, and Richard Johnson. Richard Johnson is a nephrologist who is likely the world’s foremost expert on fructose. Rick has agreed to co-author a paper with me that includes the CARB syndrome concept. It is under consideration for publishing.
A few years ago, all the top Neuroscientists in the world got together and formed a group called “The Brainstorm Consortium.” Their goal is to figure out how the brain works (good luck with that). They published their first paper in Science in 2018, and guess what—they found that ten common brain disorders appear to be part of the same disease process.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2765962?guestAccessKey=2722af68-babd-4628-a09c-8076b9d92315&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamapsychiatry&utm_content=etoc&utm_term=090220
I looked through their long list of references and noticed that they didn’t cite the prior art—Hudson and Pope’s Affective Spectrum Disorder article. I sent a letter to Science suggesting that they retract the article for ethical reasons, but I didn’t receive a response.
I thought you might enjoy learning about this new concept. Please let me know if you have any questions.
Regards—
William L. Wilson, M.D.
Beverly, MA
612-321-6654
CARB syndrome Anxiety in Children is Easily Preventable, Reversible and Treatable
So how did I do? I just sent the email, so I have yet to receive a response. In my opinion, this type of ignorance on the part of highly trained professionals is tragic because of the harm it does to countless children and their families. If a child fits the CARB syndrome pattern, treatment is straightforward, inexpensive, benign, and it just about always works very well when patients comply. In my book “Brain Drain,” I teach people to make their own self-diagnosis of CARB syndrome and arrange for their own treatment. This self-diagnosis is necessary because at present, most physicians are unaware of the disorder. I’m working on that, but when you tell the experts that they are dead wrong, you end up spending a lot of time trying to stay off the cross or getting burned at the stake!
The good news is you don’t have to wait for these clowns to get their act together. Take the bull by the horns and defeat this beast with high-quality information. Parents can easily use this information to banish anxiety in most children. And please remember, as a father of a calm six-year-old daughter Rafaella, I am rooting for you because I know the joy of living with a child free of anxiety.
