Nutritional Research Updates in PANDAS

PANS and PANDAS are debilitating neuroimmune disorders that affect children. For an overview of the difference between Tourette syndrome, OCD and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) see Dr. Zelfand’s article: When a Tic isn’t a Nervous Habit (PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)

Conventional treatments for PANS and PANDAS include repeated antibiotics, steroids, and in severe cases IVIG treatments.  For a full research review see this article: Treatment of PANDAS and PANS: a systematic review

These treatments can be very effective for some kids, but unfortunately not so effective in others.  Either way, long term medication use leads to other adverse effects.  Integrative treatments with naturopathic medicine can help decrease the need for long term medication use. 

Let’s look at a few of those treatments.

Vitamin D:

Vitamin D has well known effects on the immune system. It helps modulate both the innate (non-specific) and adaptive (specific/acquired) immune systems.  Deficiency in vitamin D is associated with both an increased risk of autoimmunity and an increased susceptibility to recurrent infections.  It is no surprise this correlation has also been found with PANDAS.

A study published by the Journal of Child and Adolescent Psychopharmacology showed that children with PANDAS more frequently have lower vitamin D levels than children who do not have PANDAS.  The results of the study showed that these levels were often under 30.  Interestingly, vitamin D levels correlated with the number of streptococcal infections prior to the PANDAS diagnosis, as well as with the infection recurrence.  This indicates the importance of proper diagnosis and treatment of vitamin D deficiency in children.  You can check out the research study here: https://www.ncbi.nlm.nih.gov/pubmed/29112476.  

Unfortunately Vitamin D is one of the most common nutrient deficiencies in children, but the good news is vitamin D levels can be easily tested with a simple blood test and treated with nutritional supplementation. As vitamin D is a fat-soluble vitamin parents should be warned to not supplement without proper evaluation, as it can be toxic in large doses.   

Xylitol: 

Xylitol (a sugar alcohol) has been found to have anti-strep activity.  An in vitro study showed that xylitol markedly reduced the growth of alpha-hemolytic streptococci, which is the species of strep bacteria associated with PANDAS.  The amount of xylitol used in this study was minimal (1 and 5%), indicating that even small amounts of xylitol supplementation may be an easy and effective treatment for reducing oral and nasal strep activity in the PANDAS population.  https://www.ncbi.nlm.nih.gov/pubmed/7486925

https://www.ncbi.nlm.nih.gov/pubmed/2790861/

Association of food sensitivity removal and symptom reduction

Many research studies have found a high correlation between mental health disorders and foods sensitivities to casein (the major protein in dairy), and to gluten (the major protein in wheat).  These studies have also found that removal of these foods caused a significant reduction in symptoms for the majority of the mental health populations tested, most notably in patients diagnosed with autism, schizophrenia, and bipolar disorders.  (links to these studies below).  While a study has not been conducted yet on the PANS and PANDAS population, one study did show a prevalence of antibodies against wheat and milk proteins and their contribution to neuroimmune reactivities.  “We conclude that a subgroup of blood donors, due to a breakdown in immunological tolerance, may react and produce significant levels of antibodies (p-values less than 0.05) against wheat and milk antigens that cross-react with different neural antigens, which may have broader implications in the induction of neuroimmune reactivities.”

https://www.ncbi.nlm.nih.gov/pubmed/24451306

https://www.ncbi.nlm.nih.gov/pubmed/27416160

https://www.ncbi.nlm.nih.gov/pubmed/21176030

As we know PANS and PANDAS are autoimmune neuropsychiatric conditions, it would make sense that removal of these offending foods from the diet in this population would help reduce the severity of immune activation and inflammation.  As with any treatment, individualization is key to help determine what diet and other treatment interventions are best for children with PANDAS/PANS.