Case history of hyperactivity

John was brought to the Allergy Clinic because of concerns about his progress at school. He was seven years old at the time. His teacher had complained that his concentration was poor and that he was giddy during class. His mother added that he sometimes 'goes wild, absolutely wild’ and that he is likely to thrash out at anyone within striking distance when he gets into one of these moods. John, for his part, was more concerned about the fact that he had frequent headache, and that he was always running to the loo with diarrhoea. He also complained of feeling tired all the time — a paradoxical symptom, given that he was always on the go and never paused for a moment's rest. During his visit, he stuck his nose into every nook and cranny of the office, mauled every valuable item on the desk, spent less than 5 per cent of the time in his chair, and was pulled back several times from expensive medical equipment. Throughout this time, he shouted several unrepeatable sentences at his mother, and interrupted our conversation frequently. John, by any reasonable standards, was suffering from hyperactivity.

Hyperactive children have long tested the patience of their parents, siblings and teachers. They have also eluded the best medical attempts to categorise and tame them! Over the years, doctors have espoused, and then rejected, countless descriptive terms for the condition. This may be because the condition is in fact a conglomeration of several different conditions with overlapping features. Thus, it is important that we agree somewhat more precisely on what it is we mean by ‘hyperactivity'.

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Depression: moody tiredness

Four years ago Paddy came down with the flu. He described himself as 'unwell ever since'. He complained of fatigue, sore muscles and bones, and a disturbed sleep pattern. So far, his symptoms could have been considered 'a possible case of CFS1 and this was the reason for his referral. However, as we delved a little further into his symptoms, Paddy gave a very clear picture of depression, and it became obvious that he was not suffering from a Postviral Fatigue Syndrome. His tiredness was described as 'a moody tiredness, a weariness — like a heavy weight holding me down'. He had lost interest in his job, he didn't feel like socialising, and he avoided situations that he had relished heretofore. He was socially withdrawn, and he had lost all sense of pleasure in life. Finally, his sleep disruption was classical of depression: he woke every morning at 4 a.m., and try as he might, he could not get back to sleep again.

We spoke at length about his depression, but we could not find an obvious cause for it. He was happily married with a few healthy kids, his business ventures were going well, he had no financial difficulties and there were no recent stresses. In spite of all that, Paddy was depressed, and quite considerably so. His fatigue was simply part and parcel of that. We should now look again at Paddy's original flu. He clearly thought it was responsible for his plight. However, we have just said that he was not suffering from a Postviral Fatigue Syndrome. What role, then, did the virus play in all of this? The answer is quite simple: viral infections not only induce fatigue states, they can give rise to depression.

Anxiety: restless tiredness
Jenny was convinced that she had multiple food allergies. She was sure that these were the cause of her chronic fatigue. She thought, for example, that onions gave her a bloated tummy, that yeast and bread gave her a rapid heartbeat, and that beef gave her diarrhoea and a jittery feeling in the pit of her stomach. However, she would still experience these symptoms when she avoided (what she thought were) her troublesome foods. That's why she thought that she had other food allergies not yet discovered.

But her symptoms were of interest in their own right. Look at them for a moment apart from the foods which were said to cause them. She was tired all the time, she had bouts of diarrhoea and a bloated abdomen, her heart was beating too fast, and she felt jittery in the pit of her stomach. These are physical symptoms of anxiety, and they call for further exploration. 'Well, yes,’ she confessed, 'I am a bit of a worrier.' Jenny frequently stayed awake for hours at night thinking about the events of the day, worrying about her children, and planning her chores for the morning. She also described having to live through many days with 'a strange feeling of something bad about to happen'. Nothing particularly bad ever did happen, but Jenny was unable to calm her mind with such reassuring thoughts. She had an anxiety disorder, and her fatigue was just a manifestation of that.

Jenny was encouraged to eat all foods, even those she thought were making her ill. Meanwhile she was given some medical treatment for her anxiety. She improved greatly over the following few months.

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Irritable Bowel Syndrome

Mavis was referred to the allergy centre presented to him with a host of symptoms, including abdominal pain, bloating of the abdomen, nausea, loss of appetite, heart-bum and constipation. The surgeon had taken a look inside her bowel and found it to be normal in appearance. Mavis was neither amused nor consoled! 'What's causing all my trouble, then?' she enquired defiantly. The surgeon, to his great regret, gave her the usual dietary advice for patients with constipation: it made her worse! It also made her desperate, and she was willing to try the Low Allergy Diet. Within seven days all of her symptoms faded into obscurity. 'Mind you,' she explained, I nearly gave up in the first few days because I got this dreadful headache, and my muscles and bones were terribly sore.' She was describing the classical withdrawal symptoms that some patients suffer when they stop eating the very thing that is making them so ill. Mavis had an Irritable Bowel Syndrome. In her case it was driven largely by food intolerance.

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Case history

Consider Abigail, for instance, a 32-year-old scientist. She was working in the research and development department of a multinational firm. One day there was a chemical spillage in her laboratory and she became violently ill. She was admitted to hospital with headache, nausea and muscle pains. That was a year ago, and she has suffered ever since. In particular, she complained of fatigue, depression, anxiety, headaches and muscle spasms. She also developed asthma and rhinitis. Some of her symptoms got worse when she was exposed to chemical smells — even smells we take for granted, such as pot-pourri and perfumed soap.

By the time she presented to the Allergy Clinic, several hospital specialists had reassured her that nothing 'physical' was wrong. By this they meant that they could find no physi­cal explanation for her symptoms. She did not have a brain tumour, her blood was healthy, and she had no obvious signs of disease. She was told that her symptoms were 'functional'. In other words, everything looked okay, it just didn't function properly.

Antidepressant medication improved her mental state con­siderably, but she was left with her most troublesome symp­toms. Having thus excluded any other explanation for her symptoms, and in some desperation, Abigail went on a ten-day Low Allergy Diet. To her great relief, all of her symptoms improved. She identified the problem foods one by one, and remains well as long as she avoids these. She is also careful to avoid chemical smells, but even these are more easily dealt with now that she is eating the 'right' diet. Abigail had Multiple Chemical Sensitivity, but most of her symptoms were due to the associated food intolerance.

This case introduces us to another important issue, namely the concept of 'total load'. Let me explain. Abigail had a pois­onous event from which she developed chemical sensitivity. This in turn led to food intolerance. Thus, she was reacting adversely to many chemicals and — although she didn't know it at the time — several foods. The total load on her system was considerable. When she reduced the load (by avoiding intolerant foods and chemical smells) she was much better able to cope with transient chemical exposures.

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