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Dr Edmond O¹Flaherty joins the debate on whether proper nutrition is beneficial in
mental illness, and if so, why?
I would like to discuss the issues raised in the article ³Autism and the gut-brain
connection², published in IMN on June 29, 2009, and the subsequent letter by Prof Billy
Burke.
The original article explained how ³there is an urgent need for clinicians to assist children
with autism who suffer from under-recognised gastrointestinal disorders and food
intolerances², according to American paediatrician Prof Anne Kelly, who was speaking at
Nutricia¹s 5th annual paediatric symposium held in Dublin.
With our existing knowledge, explained Dr Kelly, clinicians have the tools to abate some
of the discomfort and painful symptoms children with autism experience.
During the course of her research project, outlined in the article, Prof Kelly wondered:
Does a bad brain lead to a bad gut, or is it the other way around?
As a GP I had no interest in this subject until 2006 when I attended in Sydney a course
for doctors on nutrition in mental health. It was given by doctors and a scientist from the
Pfeiffer Treatment Centre in Chicago and one of the topics covered was autism.
I met parents of autistic children there and saw how well the children were doing
compared to the new cases, which had just come in for the first time. The aim was to get
the biochemistry right so that the children should be fit to attend regular school classes by
the age of five. Pfeiffer has seen over 20,000 psychiatric patients from all over the world,
including 4,500 with autism spectrum disorder (ASD) and they specialise in biochemical
treatment of mental illness.
They carry out over 100 tests on each patient and then prescribe nutrients to deal with any
chemical imbalance they find. If they find no imbalance they cannot help the patient, and
this happens in about 10 per cent of cases.Their therapy is designed to work with normal
medical and psychiatric treatment.
Among their research findings are the following: There is an elevated unbound copper in
autism. The mean serum copper/serum zinc ratio is 1.63 in autistic children with a
standard deviation of 0.54. Controls show a figure of 1.15 with a standard deviation of
0.24. Autistic children have a mean level of plasma zinc that is 28 per cent lower than
controls. Some 31 per cent of ASD patients had a history of constipation.
One of the routine tests they do is an adbominal X-ray to check for faecal retention.
Autistic children are low in metallothionein and have other biochemical inbalances which
are largely correctable by nutrients (amino acids, vitamins, minerals, and essential fatty
acids, depending on the test results) though medication is used as required too.

Many patients benefit from a gluten and casein-free diet. It appears that if the gut is not
functioning properly, short chains of peptides instead of separate amino acids are
absorbed through the gut wall and they cannot be used in the manufacture of the 300 or
so neurotransmitters that are made and broken down 24 hours per day in the brain.
The whole idea of oxidative stress would seem relevant in autism, in fact, as it does in so
many cases of mental health problems. For a child to make a good recovery they need to
start nutrient therapy by four years of age, although some improvement can be seen in
older children too.
I would see a great benefit for children, parents, and the exchequer if this were done. I
suggested it to the Departments of Education and Health in 2006, but, while they
acknowledged my letters, they appear to have done nothing about it.
Knowing about the biochemical aspects of psychiatry is enormously helpful. I will
mention just one case where the gut was critical. I saw a 36 year-old woman over two
years ago who had spent a total of over two years in hospital in 10 admissions in the
previous 18 years, with bipolar disorder mostly. Among the tests I did was to tick the
coeliac lab test on the routine blood test form. It was positive and subsequent duodenal
biopsy confirmed coeliac disease, although she had minimal symptoms.
This woman has followed a gluten-free diet since and her psychiatrist has gradually
reduced her medication. She started to feel herself getting better within a month, has been
very well for two years now and has lost four stone in weight.
Four per cent of those with a history of psychosis have only coeliac disease, according to
Pfeiffer. I have picked up several other cases of coeliac disease too and I now believe the
coeliac antibody test should be done routinely in all psychiatric patients. I think it will be
very hard in the future to defend in court a case where coeliac disease is missed in
psychiatry because a doctor has not ordered this test.
The place of the gut in mental illness looks to me to be significant in many psychiatric
conditions including depression, schizophrenia, bipolar, ADHD, violent behaviour,
Parkinson¹s disease and Alzheimer¹s disease. If the gut is working right and breaks down
proteins properly the manufacture of the proper level of neurotransmitters is much more
likely to be normal. Proper levels of other nutrients are critically important too, of course,
but are much easier to get right.
The combination of medication with proper brain nutrition is far more beneficial in my
opinion than medication alone and can often make a really good improvement even in
some chronic cases. I have noticed a few psychiatrists recently writing prescriptions for
the amino acid tryptophan (a precursor of serotonin).
Perhaps they may extend their range to cover other nutrients in due course. In the past
month I have seen for the first time a psychiatrist order a test for caeruloplasmin, an

invaluable test in nutritional psychiatry and which I order routinely. If it is low, gut
function is likely to be impaired in many cases.
Ultimately GPs may have to deal with this topic as our patients deserve to get the full
range of treatment available for mental illness and they are certainly not getting it at
present. In the UK, they have started a few courses for psychiatrists on the topic recently.
The one area where nutrients even when combined with medication are rarely effective is
in severe OCD, although I have seen a good response in a small number of such cases.
I would like to be able to mention a book that covers nutrition in mental health in detail
but so far have not found one. However, the recently retired chief scientist from the
Pfeiffer Centre, Dr William Walsh, PhD, has received a significant grant from a
foundation to write such a book and is more than halfway through writing it. I look
forward to its appearance sometime in 2010.
References available on request
Dr Edmond O¹Flaherty, GP, Blackrock, Co Dublin