June 25, 2009


The Depression Cure: The 6-Step Program to Beat Depression without Drugs. By Stephan S. Ilardi, Ph.D. Da Capo. $25.

Eating for Autism: The 10-Step Nutrition Plan to Help Treat Your Child’s Autism, Asperger’s, or ADHD. By Elizabeth Strickland, M.S., R.D., L.D. Da Capo. $17.95.

     The medical miracles of the 20th century, which vastly extended the lifetimes of millions, have become passé in the 21st, with a groundswell of people proclaiming that medications are not the answer to many diseases and chronic conditions – that, indeed, they may make matters worse rather than better. Most of the “evidence” for these positions is anecdotal rather than scientifically valid, and that is scarcely a surprise: the placebo effect shows that people given sugar pills (or their equivalent) frequently get better, largely because they believe they are getting effective medication and, equally important, are being closely observed and cared for. Opponents of medication – call them pharmaskeptics – turn their attention in particular to chronic, difficult conditions that can be mitigated but not cured by traditional medical treatment. These include mental illnesses and behavioral problems, among others.

     Many promoters of treating medical conditions without medicine are charlatans. Their claims are often transparently loopy, as in the laetrile-from-peach-pits-cures-cancer assertion a few years ago. Today, scammers and well-meaning but misguided pharmaskeptics are more likely to promote “nutraceuticals” and products with impressive-sounding chemical names that they claim (typically in ads filled with anecdotal testimonials) are available only for a limited time or in a limited way, but without a prescription – taking advantage, in the United States, of a major loophole in regulation that allows dietary supplements to be marketed without the proof of efficacy required of prescription medications.

     But – and it is a very large “but” – not all advocates of non-drug treatment of serious conditions are hucksters, and not all such treatments are valueless. There is compelling evidence that certain forms of nutrients and certain lifestyle elements, such as regular exercise, have a strong correlation to health – think of folate enrichment being used as a way to prevent serious birth defects. And both Stephen Ilardi, an associate professor of clinical psychology at the University of Kansas, and Elizabeth Strickland, a registered dietitian and specialist in nutrition therapy, have the credentials and experience to back up their assertions about non-medication approaches to serious conditions. This does not mean their ideas will work for everyone all the time; indeed, the word “cure” in the title of Ilardi’s book is an overstatement compared with the more modest “help treat” in Strickland’s. But if you approach these books as sources of potential alternative – or supplementary – treatment plans, you can pick up a lot of valuable information and perhaps ameliorate, if not cure, some serious problems.

     Ilardi, however, does not see his approach as a supplement to drug treatment for depression, but as a replacement for it. Using patient success stories – that is, lots of anecdotes – he says that depression can be defeated by focusing on lifestyle elements that have fallen by the wayside for many people in our industrialized age. His primary dietary recommendation is to consume substantial amounts of omega-3 fatty acids, found mainly in fish; and there is indeed scientific evidence of these compounds’ benefits (although not specifically relating to depression). His other ideas are in the social and behavioral spheres: exercise to stimulate serotonin and other brain chemicals; do things you enjoy so your mind does not turn to negative thoughts; keep your circadian rhythms regular by ensuring sufficient exposure to sunlight; maintain a strong social support network; and develop healthful sleep habits. These ideas are unexceptionable and certainly have value for anyone, not only for people with depression. But for people who are depressed – certainly those with a clinical diagnosis, not ones merely “feeling blue” – they constitute a somewhat naïve prescription. Depression causes withdrawal from social situations; it makes sleep difficult; it makes it difficult to get moving at all, much less in the active way required for exercise; and it prevents sufferers from engaging in enjoyable activities or even identifying activities that would be enjoyable. This “black dog,” as Winston Churchill called his depression, is a controlling factor in life. Ilardi is aware, at least to an extent, that his prescription has flaws – “increasing social connection is easier said than done,” he writes at one point. But his upbeat ideas about overcoming difficulties are themselves much easier to suggest than to implement. In the case of social connection, for example, they include educating friends about your depression, asking them for help, maintaining video or Internet friendships, reaching out through church and volunteer groups, caring for animals, and so on – all fine ideas, but none practical for someone who is truly depressed. Indeed, Ilardi’s comment that “all of us are born to connect, hardwired to live in the company of those who know and love us,” is likely to make an isolated, indrawn depressive feel even more hopeless. Ilardi’s book is useful in many ways – his appendices, a “depression scale” and symptom tracking chart, are a particularly good idea – and his chapter “When Roadblocks Emerge” acknowledges that his book will not work for everyone, “at least not right away.” But still, Ilardi’s unrelenting certainty that depressives can be cured through lifestyle changes flies in the face of the realities of life – and disease – that many depressives, and those who care for or about them, encounter day in and day out. Churchill, after all, attempted to ward off his “black dog” with compulsive overwork and excessive drinking, but even though those approaches worked for him – to a remarkable degree – it would scarcely be responsible to recommend them to others. Similarly, Ilardi’s far more benign ideas, as useful as they can be, are far from a panacea.

     Nor does Strickland have the answer to autism, Asperger’s and related conditions – but she may have an answer for some people, some of the time. This group of conditions – not everyone calls them “diseases” – remains poorly understood. Their behavioral components vary, as do their onset and their progression before and during treatment. Treatment options also vary; none is fully satisfactory. A nutritional component makes intuitive sense: certain foods, such as refined sugar, are known to cause behavioral changes in many children, so it makes sense that they would do so in children with autism, Asperger’s or ADHD as well – and perhaps to a greater extent, since the sensory response of children with these conditions often seems to be exaggerated. Therefore, it is sensible to limit affected children’s exposure to substances that may worsen the behavioral manifestations of their conditions. This also promotes healthful eating in general, and that is certainly a good thing. Strickland talks about artificial colors and flavors, preservatives and sweeteners, trans fats and pesticides, and all the other modern bugaboos of the healthful-eating movement; but she is to be commended for doing so as a clinician, not an advocate trying to score political points. She is too quick to accept anything labeled “organic” as inherently superior, and she is naïve about parents’ stress levels and time availability in suggesting that a child get three small meals and two to three snacks a day – that is, food every three hours – and that the focus of eating be on whole grains, legumes, oatmeal, starchy vegetables and so on. This is a Puritan-ethic approach to food and is likely to increase the tension of parents already pressured by having a child with, say, ADHD – especially if they have more than one child. Still, Strickland mitigates the absolutism of her prescription by providing dozens of appealing recipes, from spaghetti and meatballs to chocolate chip muffins. She emphasizes cooking without gluten or casein – more substances that may affect some children, if not all. And she provides loads of tabular material (probably too much for most people to absorb) on foods’ protein and fiber content and calcium levels, recommended daily intakes of various food-based or supplementary nutrients, and more. She sprinkles the text with stories – those anecdotes again – of children whose conditions improved when their nutrition was modified. And she writes throughout in a straight, no-nonsense style, even when saying such things as, “Pyridoxine and Pyridoxal 5-phosphate (P5P) are not the same thing. …Some healthcare practitioners believe that autistic children may have difficulty converting pyridoxine to P5P, so they suggest using supplemental P5P or a combination of pyridoxine and P5P supplements.” Strickland’s treatment of issues such as this one is detailed to the point of nitpicking, but of course parents seeking help for a child with autism, ADHD or a related condition will want all the assistance they can get. The main thing missing in Strickland’s book is a certain level of humility. An acknowledgment that nutritional changes are not necessarily the answer to the conditions she studies would be welcome; so would a statement that she understands the additional difficulties her approach asks already frazzled parents to assume as they try to cope with children’s conditions that produce more than enough stress on their own.

1 comment:

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