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George von Hilsheimer, The Humanist Press, MALABSORPTION AND DELINQUENCY A way the hypothalamic choreographer might be deranged is by malabsorption syndrome. If this suggestion is valid it directly leads to some simple therapeutic guidelines and implications for inexpensive and productive research. Malabsorption might result from:
Malabsorption would result in:
I suggest that malabsorption syndrome is a whole complex of
metabolic disorders which interact with psychosocial stress, infection, allergies and endocrine disorders.
Malabsorption is a stressor in itself. Malabsorption is associated with high levels of circulating adrenocortocotrophic hormone (ACTH) and with high levels of acetylcholine (ACh). ACTH and ACh are in turn associated with modes of learning which are characterized by poor habituation (the animals do not learn or unlearn well), by high levels of avoidance, by efficient escape conditioning, by neophobia and by poor instrumental conditioning. The experimental evidence suggests that children with malabsorption will often be similar in their electrophysiological and conditioning patterns to animals with lesions to the hypothalamus and to the hippocampus. (Di Sant'Agnese & Jones, 1962.) Background The term "malabsorption syndrome" describes the symptoms caused by impaired intestinal absorption of nutrients. This syndrome characteristically causes diarrhea, seatorrhea, weakness, weight loss, vitamin deficiencies and hematologic abnormalities to appear. The onset of this syndrome may be sudden or insidious. A thorough review of the condition is found in Losowsky, Walker and Kellerer (1974). Celiac disease, and adult celiac disease (also known as nontropical sprue), carbohydrate intolerance and pancreatic deficiency may also be considered in a differential diagnosis. Many authors have remarked on the similarity of the symptoms of sprue and celiac disease to schizophrenia (Dohan, 1969). Abnormal levels of hydrochloric acid in the stomach are associated with hysteria and neurosis (Hepler, 1970). The classic celiac syndrome is said to occur in about one case in every two thousand patients seen by pediatricians, and there is a similar frequency of nontropical sprue in adults. However, one authority (Hodgkin, 1973) reported seeing only one case of celiac disease and no sprue in ten years on a British National Health Service with 2500 patients. My own experience is that many physicians are reluctant to diagnose celiac disease and that the variability of its frequency as a diagnosis may be even greater than that among expert clinicians diagnosing diabetes from laboratory results (viz. from 2 to 76%. Jarrett & Keen (1976)). Wheat or Gluten Sensitivity Hemmings (1976) reports that circulating blood is flooded with foreign protein after meals when many large molecular weight breakdown products invade the blood stream. He says that 60% of bovine immmunoglobulin (Ig) G labelled with radioiodine is recovered as breakdown products from rat tissue eight hours after feeding; and that 46% of alpha-gliadin is recovered as breakdown prdoucts 24 hours after feeding. Alpha-gliadin is complexed in serum, which suggests it may directly interfere with the biochemistry of the body. Alpha-gliadin is the active toxic fraction of gluten in celiac disease (Baker, 1975). Giadin digest causes at least third grade toxic effects in all cells tested (lung, intestine, adrenal, kidney and carcinoma of the larynx) within five hours in celiac patients and in normal controls. Oral papain seems to protect against the toxic effect of gluten (Messer & Baume, 1976). Jellife and Jellife (1976) indicate that the gut is "open" and absorbs markedly more large molecule products in the first six months of life than later. Cow's milk fed babies consequently have less competent immune systems, more allergy and high risk for lipid abnormalities than breast fed babies who are substantially protected from these effects. The lymphocites from celiac patients react specifically to a subfraction of gluten; similar immune responses are seen in other diseases (Gowand & McGregor, 1965). The disease may spontaneously remit and patients may tolerate wheat for years, then, for unknown reasons, the disease may recur and respond to a gluten retricted diet (MacGregor, 1976). Scott and Losowsky (1975) in an extensive review found celiac disease to be associated with many other diseases, particularly autoimmune disorders, or immune deficiency diseases, hypo- and hyperthyroidism, myxedemic madness, and elevated ACTH and ACh. Hypoglycemia is frequently associated with celiac disease. Celiac syndrome may appear quite late in life (Hamilton et al, 1976); may present without jejunal anomalies in the first biopsy, and the tolerance for gluten may be high. The disease may be stimulated by an abnormally high intake of grain products (Sewell & Blenkinsopp, 1976). Gluten's effect is similar to that of plant lectin and may act as a
lectin due to cell abnormality. Gluten sensitivity has been seen as a sequel to viral infection, and then may be
progressive. The first degree relatives of celiac patients have changes in jejunal cells
similar to celiacs at a frequency 300 times that of the general population
(Weiser & Douglas, 1976). Both soya meat and bread extracts cause severe cytotoxicity (whole-meal bread is less toxic than white); but serum abolishes cytotoxicity. Soy lectin does not appear to be cytotoxic but wheat lectin causes cell rounding and a toxicity distinctively different from that of gluten and bread (Freed & Cooper, 1977). The lymphocites of celiac patients show a marked increase in DNA synthesis after in vitro incubation with a subfraction of gluten which is not shown by the cells of controls. This results in an immune sensitization (Sikora et al, 1976). Alpha-tocopherol deficiency may be seen in patients with the impaired fat oabsorption of celiac disease. The effect of Vitamin E's protection against toxins may be lost in these cases (Binder, 1965). This is also true for Vitamin D, and consequently, severe problems of bone metabolism are often encountered (Losowsky et al, op cit). The efficiency of the absorption of nutrition in the gut is strongly affected by the balance of nutrients and by the presence of benign microorganisms which assist in absorption and proudce essential vitamins (Scrimshaw & Young, 1976; Rettger et al, 1935). In an extensive survey Dohan (op cit) concludes that some
schizophrenias may be due to wheat or to gluten intolerances. Singh and Kay (1976a, b) gave either gluten or a soy placebo to schziphrenics in a double-blind, cross-over study. The gluten caused regression in those patients who were least responsive to tranquilizers. The authors argue that since anticholinergics cause regression in schizophrenics who are most responsive to tranquilizers, then the effect of gluten is clearly different from the effect of the anticholinergics and gluten's pathway of action may be an immune, allergic or toxic reaction. The side effects from neuroleptic tranquilizers were no different during the gluten and gluten-free periods of the study. Celiac "disease" is more properly called a syndrome. It appears to be associated with and to mimic many other diseases. The point of view that it is a very rare inborn error of metabolism which appears only in a classic form in very young children and is not seen in modified or in subclinical forms is not supported by the literature. Proteinurias During stress reactions the gut is passively permeable for many substances which are normally rejected. For example, oral adrenalin and histamine are toxic to an animal under stress but are not normally toxic. Horse serum, given by mouth, is sensitizing when an animal has first been stressed, but normally it is not. Endogenous metabolites which do not normally produce immune reactions will do so under stress (Selye, 1950). It is well known that excessive concentrations of amino acids in the blood are highly toxic to the central nervous system (CNS) in certain inborn errors of metabolism; but toxicity caused by dietary imbalance may occur without an inborn error (Dodge et al, 1975). More than 20 studies reviewed by Dodge and his colleagues indicate that monsodium glutamate produces lesions of the hypothalamus and that pyridoxine buffers this effect. Eating disproportionate amounts of amino acids may provoke metabolic difficulties which mimic inborn errors of metabolism(Clark, 1965). Vitamin Dependency Hunt and his colleagues (1954) first suggested that some patients might have an infirm requirement for very large amounts of vitamins. The development of the evidence for vitamin dependency is thoroughly reviewed by Scrivner (1973). Vitamin dependency might also be a functional disorder. Diani (1975) showed that sucrose diets produced muscle and nerve degeneration, loss of absorptive cells, blood vessel lesions and signs of infection in the intestines of diabetic Chinese Hamsters which were similar to findings in human intestines (also see Fordtran, 1975). Sucrose, meat, alcohol and stress reduce or eliminate the normal stomach flora. Vitamin K (as well as B vitamins) is synthesized by the intestinal flora. Intestinal flora are commonly deficient in malabsorption syndrome (Gordon, 1975). Cantor and Eichler (1977) found that sweets, like opiates, are "super normal reinforcers:, and Levin (1977) has linked sugar to hyperactivity. Frequent bruising is a symptom of Vitamin K deficiency and also of food allergy (Rea, 1976). Part of the folk lore of correctional institutions is that delinquents are sugar addicts and that they bruise readily. Long Term Effects of Malabsorption The development of the hippocampus and the supply of neurotransmitters are peculiarly vulnerable in the newborn and require adequate supplies of thiamin and pantothenic acid, in particular. If these coenzymes have been deficient, an imbalance of lactate to pyruvic acid will often persist (Winick, 1976). When pantothenic acid is low the adrenals produce insufficient steroids (Beau et al, 1955; Notwosky, 1968). Winick (ibid) also noted that the ratio of pyruvate to lactose is imbalanced in adults who suffered hypoxia and glucose deficiency at birth or during infancy. I found this imbalance in 18.5% of 101 delinquents surveyed (von Hilsheimer, 1977). Victor et al (1971) indicated that this imbalanced ratio could be due to thiamin deficiency. Axelrod and Trakotellis (1964) reported that pyridoxine deficiency impairs cellular and humoral immunity; Davis et al (op cit) suggested that pyridoxine deficiency in the fetus may cause permanent immune defects. Pyridoxine is also related to thyroid efficiency (Fisher, 1971; Pitman, 1971; Rivlin, 1971). Pyridoxine deficiency results in major anomalies (Davis, 1970) and other problesm (Coursin, 1972). Given the dietary habits of Americans generally, youth in particular, and delinquents as an especially horrible example, these deficiencies need not be due to malabsorption. Shneour (1974) reported that one out of three preschool children are at serious nutritional risk by common standards. Teen-aged mothers, in particular, have exceptionally poor nutrition and increasing numbers of teenagers are mothers (Birch & Gussow, 1970). Hill and his colleague (1977) have replicated three earlier American studies by finding serious nutritional deficiencies in general surgery patients. Many of our delinquents receive psychoactive drugs and it is well established that vitamin deficiencies and derangement of insulin production can follow drug treatment (Frenkel et al, 1973; Millichap, 1969). In 1945 Weston Price (1970) reviewed an enormous number of field observations that he had made of preindustrial populations before and after they were introduced to a modern diet. He reported a significant increase in anomalies of the face, palate and teeth of children who were born after the introduction of white flour, refined sugar and processed foods. Price found that in Melanesian, Polynesian and Scottish populations where economic factors or war had caused isolated villages to rever to their preindustrial diet, the anomalies did not occur in children born a year or more after reintroduction of the native diet. Price observed Swiss, Scotch, African, Polynesian, Canadian Amerind, Peruvian Amerind, Malanesian, Maori and Australian ahoriginal peoples in a variety ofsituations. When Price examined teeth and apalats from thousands of skulls associated with these peoples, he found that the older skulls did not have dental irregularities and bony anomalies of the face and mouth, but that these anomalies began to appear in significant numbers at the time the Western diet was introduced. Pasamanick and Knobloch (1966) reviewed a large number of studies and concluded that toxemia and anoxia, cerebral palsy, epilepsy, mental retardation, behavioral disorganization, and reading disability are functionally related to dietary deficiency. Other variables also linked to these problems (i.e., race, socio economic stress and weather) appear to be triggers for the background dietary stress. In other words, if your diet is very good then stresses are ignored. Winick, Katchadurian Meyer and Harris (1975) have shown that children who were markedly malnourished before the age of two are significantly shorter and have lower IQ's than those from the same group (Korean orphans adopted into American homes) who were well nourished. This effect persists despite the fact that the adoptive homes were all superior in income, education and parental IQ to the generality of homes in America, and that the malnourished and well nourished orphans adopted into these homes were above IQ norms and achievement ranks for American children. Even in an enriched environment, early nutritional stress retards development. Lipids The discovery that phenylketonuria (PKU) is a disease of amino acid metabolism due to an heritable enzyme defect, provided a model which led to the discovery of many heritable neurological disorders. There are now nearly 150 well mapped inborn errors of metabolism (Brady, 1976), a considerable number of which are essentially sphingolipidoses (O'Brien, et al, 1972). These and less well traced abnormalities have been reviewed by Rosenthal (1970) and are associated with the vitamin responsive inborn errors reviewed by Scrivner (1973). Lipid-free diets prevent reproduction; esperimental diets deficient in essential fatty acids cause skin rash, small brain, delayed growth, incomplete brain cell division, high neonatal mortality in the second generation and other disorders in animals (Cantarow & Trumper, 1975). Vulnerability of lipid metabolism is illustrated by the metabolism of linoleic and linolenic acid. These two essential fatty acids do not themselves appear in brain phospholipids but are desaturated in the liver to form long chain polyunsaturated fatty acids which are then used in the CNS. This biomagnification process is inhibited by disease, by deficient diet and where genetic error is present (Crawford, et al, 1976). Fleischman and his colleagues (1975) in a preliminary report on a pilot study for this investigation noted that: the actions of the anti-psychotoc drugs in enhancing dopamine turnover (Matthysse, 1973); the coordinated functioning of neural transmitters-gamma- amino-butyric acid, dopamine, acetylcholine and glutamic acid (Roberts, 1973); and symptoms associated with dysfunctions in brain circulation (Issidorides, 1971), all suggest a central role for lipids in any biological model for psychopathology. Selye (op cit) reported that stress results in increased secretion of ACTH, lymphopenia, eosinopenia, polymorphonuclear leucocytosis, lympolysis, increased phagocytosis and antibody formation and gluconeogenesis (non-sugars transformed into carbohydrates); these results may be reversed in stress of long duration which is similar in its effects to longitudinal treatment with glucocorticoids. The blood cells in capillaries tend to agglutinate into irregular clumps, changing blood to a circulating sludge. Louvett-Doust obersved this sludging of blood in schizophrenics (personal communication). Such sludging results in endothelial anoxia of the stagnant type which is followed by thrombi (and can readily be studied on the bulbar conjunctive). Anti-coagulants do not prevent the sludging but transfusion of saline, glucose, plasma or whole blood tend to break up the agglutinated masses. Cells tend to adhere temporarily to the blood vessel walls and then the count will rebound so that esosinopenia (etc.) is followed by esinophila (etc.). The interaction of these immune mechanisms with lipids is well established; cholesterol falls after surgery, hemorrhage, radium and X-ray treatment and other stresses; ACTH treatment diminishes cholesterol (CL) in man after six to eight days of treatment (45% fall in esterified, and 28% fall in free CL. This effect is not related to diet since normal animals fed a fat free diet will have normal CL content in organs and sometimes a slight incread, while the adrenal lipids are severely depleted in the adaptation reaction. Kurtz, Levy and Kanfer (1972) reported that cerebral sphingolipids are reduced 30 to 50 per cent in pyridoxine deficient rats. Maniero et al (1973) demonstrated that the brain phospholipds (PL) are more dynamically involved with pyridoxine than PL from other organs. Pyridoxine deficiencies in formula fed infants resulted in irritability and seizures which required injections of 100 mg of B-6 to remediate. The PL accunt for 20 to 25 per cent of the dry weight of mammalian brain, the bulk of which is a component of myelin sheaths. The total lipid deposition can be used as a measure of myelin synthesis because of the low turnover in myelin. The total quantitity of PL may be associated with the degree of arborization, or maturity, of the dendrites (Salvadori, 1976; Winick, op cit). Lipids provide the basic substrates for the nervous message tranport system. Lipids also provide a flag for immune ractions affecting the CNS since loss of certain lipids (notably sphyngomyelin and cerebrocide) into the blood stream indicates lysis of CNS cells (Fishman & Brady, 1976; Schettler, 1967). The lipoprotein transport system must have PL to function. The normal range of the ratio of PL to CL is 1.00 to 1.2 (Frankel & Reitman, 1963). If PL is high in relation to CL it suggests: 1..leakage from the cell walls where it is a major constitutent a. damage associated with coronary disease (Cramer, 1961); b. lysis of cerebral cells. 2.Underproduction of CL due to elevated ACTH (Brown & Goldstein, 1976; Catt, 1971). Phospholipid (PL) could be elevated in an immune reaction involving the nerve sheath and brain cells. Central nervous system damage would liberate sphyngomyelin and cerebrocide (which consists of sphygomyelin plus a galactose molecule or two bound glucose molecurles). If galactose levels are elevated with a high PL/CL ratio it would suggest that the high PL resulted from breakdown of CNS cells. Leopold and Kermer (1961) suggested that leucocytes interact with lipid metabolism. The lysosomes, which are central to immune reactions, are lipoproteins; and other phospholipoproteins are also are also involved in immune ractions (Rappoport, 1973). Diets high in cow's milk often are associated with an essential fatty acid deficiency as well as with milk intolerance. Cow's milk allergy is the most common childhood allergy and is especially high in children who were not breast fed (Jellife & Jellife, (1976). Pantothenic acid is also required for efficient metabolism of lipids, and when the hoxos monophosphate shunt in the citric acid cycle is utilized the demand for thiamin and pantothenic acid is increased. Pantothenic acid is a constitutent of coenzyme A (which is the cofactor for acetylation, especially of acetylcholine) which is utilized in the metabolism of carbohydrates, fats, protein, synthesis of fatty acids, cholesterol and other steroids. If these metabolic pathways were deranged because of malabsorption, or hyperimmune reactions stimulated by the toxins procuded in malabsorption, the lipoprotein structures in the brain would be highly vulnerable. The mean half life of protein in the brain is about 14 days (four grams synthesis per day). The brain lipoprotein molecules are very dynamic and the constitutent amino acids are constantly moving into and out of the protein molecules (Roberts et al, 1970). Trace minerals are not generally regarded as important mediators of lipid metabolism; however, Fleischman (1966, 1967) has reported normalization of blood lipids in patients at risk for cardiac disease by the use of calcium Rimland (1977) reported that phamacological doses of pyridoxine produced irritability in young mental patients which was relieved by magnesium. Moore and Fleischman (1975) reported on a number of interactions of trace minerals with psychophysiolocial measures in delinquents. Trace Minerals Zinc
Ascorbic Acid Stone (1972) reviewed the literature documenting the involvement of ascorbic acid in a large series of biochemical interactions. Stone suggests that the primates (including man), guinea pigs and the fruit bat suffer an inborn error of metabolism, namely that they cannot manufacture ascorbic acid as do other mammals. He states that the need for ascorbic acid varies enormously in humans. If man's requirements under stress are comparable to the amounts manufactured by other animals, the needs of delinquents should be substantially greater than several grams daily. Varicose veins under the tongue were discribed by Lind 200 years agoas a sign of scurvy. In 1976 Taylor reported that the endothelium of small blood vessels repture when ascorbic acid is deficient. This phenomenon is frequently seen in the elderly, and in some younger people, but is rarely seen in vegetarians or after supplements of ascorbic acid. Taylor (1976) reviewed studies which show that even when plasma levels of ascorbic acid remained relatively high, healthy young men deprived of Vitamin C for only a month exhibited vascular changes with petechial hemorrhages in the skin, under the tongue and in the conjunctivae. Ascorbic acid deficiency is associated with collagen damage, decrease in phagocytic action of white cells of tyrosine metabolism, thyroid and adrenal efficiency and platelet aggregation. Ascorbic acid levels fall below 15ug/108 cells in normal people after a cold. Capillary fragility increases in diabetics who have normal blood levels of C but is reduced by a one gram daily supplement. Chronic low C disorders the lipid metabolism and increases the level of cholesterol. Wilson (1976) notes that ascorbic acid potentiates antibiotics and is depleted in the leucocytes and plasma by the common cold and in allergy. When given with aspirin the uptake of both is enhanced. Sprince (1976) demonstrated that ascorbic acid interacts with drugs that block the effects of the catecholamines, greatly increasing their efficiency. Halliwell (1976) reported that the toxicity of hyperbaric oxygen in rats is lowered by ascorbic acid which enters the lung tissue and binds superoxide; he suggested the use of high doses of ascorbic acid in insecticide poisoing (paraquat). The use of substances with similar antioxidizing effects has been substantiated in other toxicities. For example, Brown (1976) reports successful use of sodium bicarbonate in detoxifying tricyclic antidepressant overdoses (also see Editors, 1976a). Randolph (1976) used intravenous ascorbic acid with sodium bicarbonate to detoxify heroin addicts. Kubala and Katz (1960) report that when dietary supplements of ascorbic acid increase the blood ascorbate, IQ also increases. Holmes and Campbell (1935) reported that ascorbic acid could be sed to reduce tissue lead burden. Hyperimmune reactions The CNS and the immune system protect the whole organism in remakably similar ways (Salk, 1969). Stein, Schiavi and Camerino (1976) reviewed the research in psychoimmunology and found substantial evidence of rich interactions among emotion, behavior and immunity. Resistance to infection may be modified by experience: In laboratory animals, avoidance conditioning, stressingly loud sounds, living in groups rather than in isolation, fighting, and exposure to predators have all been shown to decrease resistance to infection; The development of neoplasms may be modified by experience:
Avoidance learning, overcrowding, grouping dominance, complex perceptual enrichment, conflict conditioning, stressing stimuli, brief handling during the nursing period, and electric shock have all been known to alter plasma levels of cortisol, levels of antibodies, timing of responses, and levels of histamine; Hypothalamic lesions effect the humoral immune responses and there is some evidence that they also modify cell mediated immune responses. Bartrop and his colleagues (1977) made the first demonstration of a post stress abnormality in immune function which was not obviously caused by hormonal mediators. They found lymphocytes severely depressed in 27 healthy bereaved spouses measured two and six weeks after bereavement. They found no difference between the bereaved and their matched controls in number of T and B cells, protein, autoantibodies, delayed hypersensitivity, or in cortisol, prolactin, growth hormone or thyroid. In 1961 Crook and his colleagues reported on 50 patients and reviewed the literature giving evidence of allergy mediated fatigue, confusion and related symptoms. Campbell (1068) reported on allergic cerebral edema with subsequent behavioral disorders. A historical review of neurological allergy was given by Davison in 1952. Rowe (1928, 1931) reported on psychological symptoms in reactions to common foods. Manfestations of human disease in transaction with the environment have been summarized in Dickey (1976). Lockey (1971) reported that salycilates in foods and other food chemicals provoked hives and other symptoms. Feingold (1973, 1976) extended this finding to include hyperkinesis in children. Hawley and Buckley (1976) confimred that discovery while demonstrating that hyperkinesis could be provoked by very dilute solutions of analine food dyes. Cunningham (1975a, 1975b) reported that 54% of the children he has seen with a history of idiopathic seizures have a history of allergic complaints (versus 34% of all patients in his clinic). Blood eosinophil counts parallels susceptibility to allergy, infection and immunodeficiency (Schlegel & Bellenti, 1969). It seems apparent that malabsorption and other lesions might induce hyperimmune reactions and that these reactions might induce behavior changes leading to delinquency. The literature reviewed suggests that if
malabsorption is a common ccurance among delinquents, then in many of them we would find
that: The literature reviewed suggests that if malabsorption is a common occurrence among delinquents then in many of them we would find that:
1. Ecology of the gut.
2. Indications of Nutritional Deficiency
3. Adrenal Depletion
4. Overactive Immune System
Preliminary Studies In 1969 I organized a strong medical program at my residential treatment center, Green Valley. We standardized an extensive medical screening on delinquents and so from 1970 through 1974, every admission to my program received a blood chemistry screening which included the Auto-Analyzer (SMAC-12, Profile II), CBC, and urinalysis (extended to include ascorbic acid and hydrocholoric acid). Glucose tolerance tests were routinely done in 1970-71. Some unusual hormones and metabolites were studied episodically. From 1970 through 1974 evry admission routinely received intradermal injections for skin reactions to at least 14 allergens plus saline and histamine. From 1965 through 1974 we examined the stools of every child admitted, for weight, fat content, parasites and composition. Results of these studies have been reported elsewhere (Fleischman, 1975; Moore & Fleischman, 1975; Klotz, 1969, 1970, 1971, 1972a, 1972b, 1973; von Hilsheimer, 1970a, 1971a, 1971b, 1973, 1974, 1975, 1976, 1977). Integrity of the Intestinal Ecology The faeces of these delinquents were characteristically loose, bulky, light in color, foul and floated; the transit time for food (from eating to elimination) was markedly slow. It was difficult or impossible to culture lactobacillus acidophilus from the faeces. An unusual number of the adolescents produced very little or no hydrochloric acid. Burkitt (1976) claims that it is impossible to get normative data on stool weight in European or American children. However, stools weight was differentially distributed in our children and was roughly associated with competence. Greater density correlated with a higher competence rating, which also conformed to observations of eating habits,. In our center all the operational staff ate in family settings with the delinquents and ethological studies of eating practices were routinely summarized. Stool fat content was significantly higher in our population compared to laboratory norms. No parasites were reported in ten years of study. If the children were divided into frequent and infrequent sick call responders the habitual sick call attenders averaged a GI complaint every six days. In their histories we characteristically found colic, poor sleep, a great deal of diaper rash, eczema, GI problems and almost a third had respiratory allergies. Unfortunately, we did not carry out immunoglobulin studies on these adolescents. However, the cells associated with allergy - eosinophils - were higher than in normal children. Developmental Anomalies A colleague and I (von Hilsheimer & Kurko, 1977) examined the minor physical anomalies (MPA) of 244 middle class and 143 lower class kindergarten children in Fort Worth, Texas; 42 small town junior high school children; 52 behavior disordered residents of a special school; 70 learning disabled residential students; 32 pupils at a special elementary day school; and 10 children with the diagnosis "autism". We found that the middle class kindergarten pupils and the junior high school students had similar numbers of anomalies. The lower class kindergarten pupils and the behavior disordered residential students resembled each other and had more MPA than the middle class and small town students. The residential learning disabled students and the day school special education pupils had similar higher numbers of MPA. The autistic children were higher in anomalies than all the other groups. These findings support a number of studies which have found a higher number of MPA in children associated with a variety of developmental disabilities including hyperkinesis and learning disability (Binkley, 1971; Daryn, 1961; Firestone et al, 1976; Rapoport et al, 1974; Rosenberg, 1973; Waldrop et al, 1968; Waldrop & Halverson, 1969, 1971). Adrenal Depletion I reported (von Hilsheimer, 1976) on ascorbic acid spillage in 149 sequential admissions to Green Valley. Not one delinquent spilled ascorbic acid on the day of admission, compared to two thirds of adolescents encontered accidentally in the school system. In the next 13 months we ran wight surveys of free ascorbic acid in the urine of our students. After a month of heroic efforts to insure that substantial supplements were in fact ingested by the students, we found 56% were spilling ascorbic acid in their urine. This was the best result obtained despite the fact that the students were receiving from 4 to 44 grams of ascorbic each every day. Ninety students ingested four kilograms each week. In the eight other surveys the percentage spilling ascorbic acid ranged from 25 to 37. In a control group in the public schools who were not taking supplements 76% spilled ascorbic acid. Klotz and his colleagues (1973) reported on three studies of the behavioral effects of food as allergen using delinquents from Green Valley as subjects. In the first study nurses were asked to report unusual behavior as positive reactions after serial dilutions of food extracts were placed under the tongue in a double blind method. There were nine positive reactions, one of which was false, in 360 trials (placebo and active allergen. Forty other subjects were observed by medically naive aides at physical education and only one dilution was given of four food extracts. Thirteen positive reactions were reported in 320 trials, three of which were to placebo. Eleven psychotic subjects were absolutely fasted, receiving nothing but spring water while living in an air filtered secure room. Eight of the eleven subjects became distinctly improved or symptom free within five days. When these eight were challenged with placebo or active fractions of food extract in a double blind method, all eight positively reacted to allergen with no false positives. These authors conclude that when a preselected panel of patients is screened the sublingual method of testing allergens is valid and reliable. The idea that common foods may provoke unusual behavior was strongly supported. Immune Reactions Klotz (op cit) reported on ten years of his clinical and research experience with delinquents at Green Valley. Only four out of 105 youngsters seen by him in 1970 failed to have significant whealing to intradermal injections of allergen (given in a double-blind method). Fleischman et al (1975) found the ratio of phsopolipids to cholesterol to be high in delinquents at Green Valley and suggested that this might be due to lysis of the CNS. He suggested that an autoimmune or other immune mechanism might be causing a loss of phospholipid. My finding (1977) that a high percentage of our delinquents had excessive glactose, a sugar broken down from phospholipids, tended to confirm this suggestion. These delinquents resemble psychiatric patients in having low immunoglobulin A, which is necessary for absorption of food (Sabiliahti 1972; Tomasi, 1968). Jellife and Jellife (op cit) reported that cow's milk intolerance is the most common childhood allery and is much more frequent in children who were not breastfed. Less than 5% of the children sent to us were breastfed babies. Losowsky and his colleaues (op cit) reported that cow's milk intolerance may be indistinguishable from gluten intolarance and may occur together. matthew and his colleagues (1977) reported that when infants are maintained on an allergen avoidance 5routine they have far fewer allergic symptoms at six months and one year than controls and a lower IgE serum level at six weeks. We found that our children ate disproportionaely large amounts of wheat, corn and cow's milk. These three substances, plus tobacco and coffee, were the most frequent foods provoking symptoms in these youngsters. Corwin (1975) reported that cooked foods, especially when they are rapidly cooked or cooked at high temperatures, are more stressing to animals than raw or slowly and lightly cooked foods. We found that our delinquents were more reactive to fast food products than to more gently cooked foods.
Our adolescents seemed markedly responsive to allergen challenge. Foods were especially provocative of florid symptoms. Other
evidence of allergic hyperreactivity such as elevated eosinophils confirmed this evidence.
If we look at the data in these preliminary reports from the
standpoint of the predictions made by a theory that malabsorption frequently occurs in delinquents the results are compelling;
Evidence for Malnutrition in Middle Class Delinquents Summarizing the preliminary reports reviewed above and looking at my delinquents in their light suggest that compared to other children:
These facts suggest that delinquents are at high risk for unusual CNS development, CNS damage, poor continuing synthesis of CNS amino acids and neural transmitters, and are extremely vulnerable to derangements of the immune and allergy systems. Comments in 1998 We studied 114 delinquents using 61 different measures.
Criminal, felon SZ, and chronic patients had the greatest evidence of malabsorption syndrome of all the subjects, who generally evidenced malabsorption. Felon SZ had lower hair Cu than SZ patients who were not actively delinquent. Minor Physical Anomalies (MPA) correlated significantly with the overall battery, and even more highly with lipids and conditioning. Lipid levels and ratios, conditioning and MPA were efficient predictors of recidivism. MPA are not likely to be a result of post natal psychosocial stress and MPA give an estimate of the biological vector in the etiology of delinquency. The data did not support unitary concepts of "brain damage", "organicity", psychosis, delinquency or learning disability. Formally adjudicated delinquents were unlike normal controls, and actively criminal delinquents were unlike status delinquents. Schizophrenics were reliably separated into three distinct patterns; LD into four; and a Taxonomic Key reliably described 9 distinct patterns of delinquency, significantly agreed with ethological observation by briefly trained volunteers (.42, p=.001). There is no reasonable basis for denying that
BIBLIOGRAPHY FOR CHAPTER THREE, MALABSORPTION IN DELINQUENTS
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