Deadly Mold in Seattle Children's Hospital

A class-action lawsuit has been filed against Seattle Children's Hospital after six children died and many others were sickened from Aspergillus mold.1 The lawsuit claims the hospital knew about "systemic problems" with its air-handling system and the related risks as far back as 2000, but "engaged in a cover-up" that left vulnerable patients exposed to potentially dangerous Aspergillus mold. Since 2001, Seattle Children's has identified 14 patients who contracted Aspergillus infections during or after hospital stays; six of those patients died as a result.2 Attorneys suggest, however, that many more children were likely affected and the numbers could be as high as "dozens if not hundreds."3 As of December 4, 2019, all 14 operating rooms at the hospital's main campus remained closed as a new air handling unit was moved into place. "We are incredibly sorry for the hurt experienced by these families and regret that recent developments have caused additional grief," Seattle Children's said in a statement. "Out of respect for privacy, we do not intend to share details about our patients or comment on specific cases or legal action."4 Hospital's Air Handling System Led to Deadly Mold Infections Patients affected by the toxic mold at Seattle Children's Hospital range in age from 2 months to 17 years.5 The infections occurred from 2001 to 2019 as a result of the hospital's negligence at maintaining and testing its facilities, leading to the transmission of Aspergillus mold spores to hospitalized children, according to the suit.6 In 2019, the hospital admitted that it was contaminated with Aspergillus mold since 2001, sickening patients as a result. Air tests conducted in November 2019 also revealed the presence of Aspergillus in several operating rooms.7 However, this wasn't a new revelation, as the suit alleges that the hospital knew by at least 2005 its air-handling system could be transmitting Aspergillus, when a family sued them over the issue. "During the course of that lawsuit troubling information surfaced regarding the Defendant's failure to maintain and staff its air-handling systems," the complaint reads. The lawsuit was settled in 2008 under confidential terms, but the hospital continued to keep "a deadly secret" in assuring patients and the public that it was safe, when in fact the mold persisted.8 Further, as early as 2002, an engineering consultant as well as the hospital's lead engineer warned the hospital about "filthy conditions" of its air-handling units, including water leaks, birds in fan shafts, units "rotting out" and failure to test equipment.9 The hospital also published an internal investigation in 2007 looking into three Aspergillus infections, but concluded they were isolated incidents. Seattle Children's CEO Dr. Jeff Sperring said in a statement:10 "As we have previously shared, Seattle Children's has had seven Aspergillus surgical site infections since the summer of 2018. We are deeply saddened that one of those patients died. As we have looked more closely at our history of Aspergillus infections, we believe there are connections between recent and past infections. Between 2001 and 2014, seven patients developed Aspergillus surgical site infections. Tragically, five of those patients died. At the time, we believed most of these were isolated infections. However, we now believe that these infections were likely caused by the air handling systems that serve our operating rooms. Looking back, we should have recognized these connections sooner." Dangers of Aspergillus Infection Aspergillus is a common type of mold found both indoors and outdoors, in decaying leaves and on plants, trees and compost.11 While most people come in contact with Aspergillus daily without any ill effects, certain strains can be dangerous for people with weakened immune systems or lung diseases. Disease caused by Aspergillus is known as aspergillosis, which can lead to allergic reactions and infections in the lungs or other organs.12 The CDC lists seven types of aspergillosis, which range in severity from mild to life threatening:13 Allergic broncopulmonary aspergillosis, which occurs when the mold causes allergy symptoms and lung inflammation.Allergic Aspergillus sinusitis, which occurs when the mold causes sinus inflammation and symptoms of a sinus infection. Azole-resistant Aspergillus fumigatus, caused by A. fumigatus, a type of Aspergillus that's resistant to certain medications used to treat it.Aspergilloma, or "fungus ball," which refers to a ball of Aspergillus that grows in the lungs or sinuses. Chronic pulmonary aspergillosis, which is Aspergillus infection that causes cavities and sometimes fungal balls in the lungs.Invasive aspergillosis, a serious infection that typically affects people with weakened immune systems; it commonly affects the lungs but may spread to other areas. Cutaneous (skin) aspergillosis, which occurs when the mold enters a wound or other skin break and

Deadly Mold in Seattle Children's Hospital

A class-action lawsuit has been filed against Seattle Children's Hospital after six children died and many others were sickened from Aspergillus mold.1 The lawsuit claims the hospital knew about "systemic problems" with its air-handling system and the related risks as far back as 2000, but "engaged in a cover-up" that left vulnerable patients exposed to potentially dangerous Aspergillus mold.

Since 2001, Seattle Children's has identified 14 patients who contracted Aspergillus infections during or after hospital stays; six of those patients died as a result.2 Attorneys suggest, however, that many more children were likely affected and the numbers could be as high as "dozens if not hundreds."3

As of December 4, 2019, all 14 operating rooms at the hospital's main campus remained closed as a new air handling unit was moved into place.

"We are incredibly sorry for the hurt experienced by these families and regret that recent developments have caused additional grief," Seattle Children's said in a statement. "Out of respect for privacy, we do not intend to share details about our patients or comment on specific cases or legal action."4

Hospital's Air Handling System Led to Deadly Mold Infections

Patients affected by the toxic mold at Seattle Children's Hospital range in age from 2 months to 17 years.5 The infections occurred from 2001 to 2019 as a result of the hospital's negligence at maintaining and testing its facilities, leading to the transmission of Aspergillus mold spores to hospitalized children, according to the suit.6

In 2019, the hospital admitted that it was contaminated with Aspergillus mold since 2001, sickening patients as a result. Air tests conducted in November 2019 also revealed the presence of Aspergillus in several operating rooms.7

However, this wasn't a new revelation, as the suit alleges that the hospital knew by at least 2005 its air-handling system could be transmitting Aspergillus, when a family sued them over the issue. "During the course of that lawsuit troubling information surfaced regarding the Defendant's failure to maintain and staff its air-handling systems," the complaint reads.

The lawsuit was settled in 2008 under confidential terms, but the hospital continued to keep "a deadly secret" in assuring patients and the public that it was safe, when in fact the mold persisted.8

Further, as early as 2002, an engineering consultant as well as the hospital's lead engineer warned the hospital about "filthy conditions" of its air-handling units, including water leaks, birds in fan shafts, units "rotting out" and failure to test equipment.9

The hospital also published an internal investigation in 2007 looking into three Aspergillus infections, but concluded they were isolated incidents. Seattle Children's CEO Dr. Jeff Sperring said in a statement:10

"As we have previously shared, Seattle Children's has had seven Aspergillus surgical site infections since the summer of 2018. We are deeply saddened that one of those patients died.

As we have looked more closely at our history of Aspergillus infections, we believe there are connections between recent and past infections. Between 2001 and 2014, seven patients developed Aspergillus surgical site infections. Tragically, five of those patients died.

At the time, we believed most of these were isolated infections. However, we now believe that these infections were likely caused by the air handling systems that serve our operating rooms. Looking back, we should have recognized these connections sooner."

Dangers of Aspergillus Infection

Aspergillus is a common type of mold found both indoors and outdoors, in decaying leaves and on plants, trees and compost.11 While most people come in contact with Aspergillus daily without any ill effects, certain strains can be dangerous for people with weakened immune systems or lung diseases.

Disease caused by Aspergillus is known as aspergillosis, which can lead to allergic reactions and infections in the lungs or other organs.12 The CDC lists seven types of aspergillosis, which range in severity from mild to life threatening:13

Allergic broncopulmonary aspergillosis, which occurs when the mold causes allergy symptoms and lung inflammation.

Allergic Aspergillus sinusitis, which occurs when the mold causes sinus inflammation and symptoms of a sinus infection.

Azole-resistant Aspergillus fumigatus, caused by A. fumigatus, a type of Aspergillus that's resistant to certain medications used to treat it.

Aspergilloma, or "fungus ball," which refers to a ball of Aspergillus that grows in the lungs or sinuses.

Chronic pulmonary aspergillosis, which is Aspergillus infection that causes cavities and sometimes fungal balls in the lungs.

Invasive aspergillosis, a serious infection that typically affects people with weakened immune systems; it commonly affects the lungs but may spread to other areas.

Cutaneous (skin) aspergillosis, which occurs when the mold enters a wound or other skin break and leads to infection.

Aspergillosis isn't a reportable disease in the U.S., which means numbers on its incidence are scarce, but the CDC estimates that nearly 15,000 aspergillosis-associated hospitalizations occurred in the U.S. in 2014, with costs of $1.2 billion.14 Further, they noted, "In a broad U.S. health care network of intensive care unit autopsy studies, aspergillosis was one of the top four most common diagnoses that likely lead to death."15

Aspergillosis Outbreaks in Hospitals

While clusters of cases of dangerous invasive aspergillosis are rare in the general population, outbreaks have occurred previously in hospital settings, particularly among immunocompromised patients.

Recently, lung infections caused by Aspergillus have been reported in people hospitalized with severe influenza and, in one study, invasive pulmonary aspergillosis occurred even in people without a compromised immune system.16 The CDC also reported:17

"Although most cases of aspergillosis are sporadic (not part of an outbreak), outbreaks of invasive aspergillosis occasionally occur in hospitalized patients. Invasive aspergillosis outbreaks are often found to be associated with hospital construction or renovation, which can increase the amount of airborne Aspergillus, resulting in respiratory infections or surgical site infections in high-risk patients.

Outbreaks of primary cutaneous aspergillosis and central nervous system aspergillosis in association with the use of contaminated medical devices have also been described. The incubation period for aspergillosis is unclear and likely varies depending on the dose of Aspergillus and the host immune response."

While it's virtually impossible to avoid exposure to aspergillus in the environment, hospitals have a responsibility to ensure they aren't exposing patients to this potentially dangerous fungus via an ill-maintained air handling system. As for Seattle Children's, they're installing new air handlers in an attempt to resolve the mold issues:18

"Seattle Children's will install a new rooftop air handler as well as custom-built, in-room high-efficiency particulate air (HEPA) filters in every operating room and adjacent supply area. HEPA is an extremely effective filtration system that removes 99.97 percent of particles from the air that passes through the filter.

This is the highest level of filtration found in operating rooms today. These operating rooms will remain closed until the enhancements are fully in place."

Is There Mold in Your Home?

Common health problems that can be attributed to poor and potentially toxic indoor air quality courtesy of mold growth include but are not limited to the following. If you have any of these issues, it may be worthwhile to consider your indoor air quality, and the possibility that your health problems may be related to mold.

Frequent headaches

Depression

Chronic fatigue

Allergies

Neurological problems; poor concentration and forgetfulness

Skin rashes

Stomach and digestive problems, such as dysbiosis, leaky gut and frequent diarrhea

Chronic sinusitis

Joint aches and pains

Muscle wasting

Frequent fevers

Asthma or trouble breathing

To determine if mold is lurking in your home, first look for signs of visible mold or musty odors. However, not all mold is easily detectable, so if you can't see any visible traces of mold, take an air sample and use a moisture meter to determine the moisture level in the area.

Wood flooring should have a maximum moisture content of 10% to 12%, for instance, as anything above that is a breeding ground for mold. Exterior walls should not have a moisture content above 15%. In addition to air sampling, proper lab testing of bulk samples of the mold growth is recommended.

This will require cutting out a piece of the affected area. The U.S. EPA has a test called Environmental Relative Moldiness Index (ERMI), which tests for 31 different species of mold. If all you have is a small area of surface mold, you probably don't have to call in an expert. However, only attempt to clean it if it's limited to the surface of a small area. Any deep-rooted mold will require professional assistance to remediate.

Mold Is Serious, Here's What You Can Do

Download Interview Transcript

Aspergillosis is an example of what Dr. Ritchie Shoemaker calls biotoxic illness. Most biotoxic illnesses are difficult to diagnose and treat as all of them, including mold, affect multiple systems in your body and produce a wide array of symptoms.

Shoemaker, a pioneer in the field of biotoxin-related illness, explains that the underlying commonality, whether the disease is caused by dinoflagellates, mold or spirochetes, for example, is chronic inflammation. The inflammation induced by exposure to the toxins and metabolic products produced by these microorganisms is what wreaks havoc on your health.

"In order to treat them, we need to both remove them from exposure and remove toxin from their body," Shoemaker said. Many of his patients have had success using cholestyramine (CSM), a rarely used cholesterol drug that binds to not just cholesterol, but just about everything of a particular molecular shape and size.

"Binding CSM to the toxin prevents its reabsorption. There's another cholesterol-lowering resin called Welchol that also has these net positive charges … Even though people have used clays — and Bentonite is one — with some success, cholestyramine is so much better that people would put up with the common side effects of constipation and some reflux," he said.

This is only the first step in his protocol, which includes 10 additional steps intended to stop the inflammatory process initiated by the mold (or other toxin) exposure. For more information, SurvivingMold.com is a great resource for medical practitioners and patients alike.19

I also discuss helpful tests and diagnostic tools for mold-related illness in "Mold: The Common Toxin That Can Be Far More Damaging Than Heavy Metals." Overall, your best approach is to find a well-informed physician with expertise in environmental medicine. Together you can devise an appropriate treatment plan. For a list of physicians with experience in treating mold-associated disease, see DrThrasher.org.

Source : Mercola More   

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Childhood Stress Can Make You Ill as an Adult

Prolonged stress can have life-threatening consequences not only for adults but also for children. Research shows adverse childhood experiences (ACEs) can predispose them to any number of health problems later in life. In the early days of mankind’s evolution, the stress response saved our lives by enabling us to run from predators or take down prey. Today, however, such dire circumstances are few and far between, yet we still turn on the same “life-saving” reaction to cope with countless everyday situations. Constantly being in a stress response may have you marinating in corrosive hormones around the clock, which can raise your blood pressure, add fat to your belly, shrink your brain and even unravel your chromosomes.1 Stress disrupts your neuroendocrine and immune systems and appears to trigger a degenerative process in your brain that can result in Alzheimer’s disease. Stress can also accelerate aging by shortening your telomeres, the protective genetic structures that regulate how your cells age. In the words of Dr. Lissa Rankin, author of “Mind Over Medicine”:2 “Our bodies know how to fix broken proteins, kill cancer cells, retard aging, and fight infection. They even know how to heal ulcers, make skin lesions disappear and knit together broken bones! But here’s the kicker — those natural self-repair mechanisms don’t work if you’re stressed!” Childhood Stress and Mental Health In a March 2020 Newsweek article,3 Adam Piore discusses the work of Dr. Nadine Burke Harris, founder of a children’s medical clinical in one of San Francisco’s poorest neighborhoods. A surprisingly large portion of her young patients struggled with symptoms of attention deficit hyperactivity disorder (ADHD), the hallmarks of which include an inability to focus, impulsivity and abnormal restlessness. Many also had severe health problems and depression. Piore writes: “Burke Harris noticed something else unusual about these children. Whenever she asked their parents or caregivers to tell her about conditions at home, she almost invariably uncovered a major life disruption or trauma. One child had been sexually abused by a tenant, she recalls. Another had witnessed an attempted murder. Many children came from homes struggling with the incarceration or death of a parent, or reported acrimonious divorces. Some caregivers denied there were any problems at all, but had arrived at the appointment high on drugs.” Alarmed by the obvious trend she was witnessing in her clinic, Harris began searching for answers in the medical literature. Was childhood trauma responsible for the poor state of health of so many of her young patients? “Childhood stress can be as toxic and detrimental to the development of the brain and body as eating lead paint chips off the wall or drinking it in the water — and should be screened for and dealt with in similar ways, in Burke Harris' view. As California's first Surgeon General … she is focusing on getting lawmakers and the public to act,” Piore writes.4 Adverse Childhood Experiences Screening In 2020, California is allocating $105 million to promote screening for ACEs, which have been shown to trigger toxic stress responses and epigenetic changes linked to a variety of health problems. As reported by Piore, the biological switches flipped during ACEs increase a child’s risk for:5 Nicotine, alcohol and drug abuse Heart disease Suicide Cancer Mental illness Dementia Impaired immune function What’s more, these stress-induced epigenetic changes can be passed on to future generations. Indeed, you will often find that childhood trauma “runs in families,” with each subsequent generation playing out the same interpersonal dramas as their parents. According to Harris, "The social determinants of health are to the 21st century, what infectious disease was to the 20th century."6 The ACE Study Much of what we now know about ACEs are the result of the 1998 ACE Study,7 which examined the relationship between childhood trauma and subsequent risky behaviors and diseases in adulthood. Categories of ACEs examined included:8,9 Psychological abuse Physical abuse Sexual abuse Violence against the mother Living with household members who were substance abusers Living with mentally ill or suicidal household members Living in a household in which a member has been or is imprisoned Early death of a parent Neglect Separation or divorce Of the 13,494 adults who received the questionnaire and had completed a standard medical evaluation, 70.5% responded. Of those, more than half reported experiencing at least one ACE; one-fourth reported two or more. Not only did they find a direct “dose-dependent” relationship between the number of ACEs and future health problems and risky behaviors, childhood trauma appeared to be an independent risk factor for leadin

Childhood Stress Can Make You Ill as an Adult

Prolonged stress can have life-threatening consequences not only for adults but also for children. Research shows adverse childhood experiences (ACEs) can predispose them to any number of health problems later in life.

In the early days of mankind’s evolution, the stress response saved our lives by enabling us to run from predators or take down prey. Today, however, such dire circumstances are few and far between, yet we still turn on the same “life-saving” reaction to cope with countless everyday situations.

Constantly being in a stress response may have you marinating in corrosive hormones around the clock, which can raise your blood pressure, add fat to your belly, shrink your brain and even unravel your chromosomes.1

Stress disrupts your neuroendocrine and immune systems and appears to trigger a degenerative process in your brain that can result in Alzheimer’s disease. Stress can also accelerate aging by shortening your telomeres, the protective genetic structures that regulate how your cells age. In the words of Dr. Lissa Rankin, author of “Mind Over Medicine”:2

“Our bodies know how to fix broken proteins, kill cancer cells, retard aging, and fight infection. They even know how to heal ulcers, make skin lesions disappear and knit together broken bones! But here’s the kicker — those natural self-repair mechanisms don’t work if you’re stressed!”

Childhood Stress and Mental Health

In a March 2020 Newsweek article,3 Adam Piore discusses the work of Dr. Nadine Burke Harris, founder of a children’s medical clinical in one of San Francisco’s poorest neighborhoods.

A surprisingly large portion of her young patients struggled with symptoms of attention deficit hyperactivity disorder (ADHD), the hallmarks of which include an inability to focus, impulsivity and abnormal restlessness. Many also had severe health problems and depression. Piore writes:

“Burke Harris noticed something else unusual about these children. Whenever she asked their parents or caregivers to tell her about conditions at home, she almost invariably uncovered a major life disruption or trauma.

One child had been sexually abused by a tenant, she recalls. Another had witnessed an attempted murder. Many children came from homes struggling with the incarceration or death of a parent, or reported acrimonious divorces. Some caregivers denied there were any problems at all, but had arrived at the appointment high on drugs.”

Alarmed by the obvious trend she was witnessing in her clinic, Harris began searching for answers in the medical literature. Was childhood trauma responsible for the poor state of health of so many of her young patients?

“Childhood stress can be as toxic and detrimental to the development of the brain and body as eating lead paint chips off the wall or drinking it in the water — and should be screened for and dealt with in similar ways, in Burke Harris' view. As California's first Surgeon General … she is focusing on getting lawmakers and the public to act,” Piore writes.4

Adverse Childhood Experiences Screening

In 2020, California is allocating $105 million to promote screening for ACEs, which have been shown to trigger toxic stress responses and epigenetic changes linked to a variety of health problems. As reported by Piore, the biological switches flipped during ACEs increase a child’s risk for:5

Nicotine, alcohol and drug abuse

Heart disease

Suicide

Cancer

Mental illness

Dementia

Impaired immune function

What’s more, these stress-induced epigenetic changes can be passed on to future generations. Indeed, you will often find that childhood trauma “runs in families,” with each subsequent generation playing out the same interpersonal dramas as their parents. According to Harris, "The social determinants of health are to the 21st century, what infectious disease was to the 20th century."6

The ACE Study

Much of what we now know about ACEs are the result of the 1998 ACE Study,7 which examined the relationship between childhood trauma and subsequent risky behaviors and diseases in adulthood. Categories of ACEs examined included:8,9

Psychological abuse

Physical abuse

Sexual abuse

Violence against the mother

Living with household members who were substance abusers

Living with mentally ill or suicidal household members

Living in a household in which a member has been or is imprisoned

Early death of a parent

Neglect

Separation or divorce

Of the 13,494 adults who received the questionnaire and had completed a standard medical evaluation, 70.5% responded. Of those, more than half reported experiencing at least one ACE; one-fourth reported two or more.

Not only did they find a direct “dose-dependent” relationship between the number of ACEs and future health problems and risky behaviors, childhood trauma appeared to be an independent risk factor for leading causes of death. According to the authors:10

“We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied.

Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, > or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity.

The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease.

The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.”

Origins of ACEs

In the June 2019 issue of the American Journal of Preventive Medicine, (full text is behind a paywall)11 Dr. Vincent J. Felitti commented on his 1998 ACE Study:

“The ACE Study was a direct outgrowth of significant counterintuitive findings derived from … the treatment of obesity in Kaiser Permanente’s Department of Preventive Medicine in San Diego, California. Unexpectedly, we discovered that such major weight loss was actually threatening to many patients.

Pursuing this, we came to realize that obesity, a major public health problem from a societal standpoint, was from the involved patient’s standpoint often an unconsciously chosen solution to unrecognized traumatic life experiences that were lost in time and further protected by shame, secrecy, and social taboos against exploring certain realms of human experience.”

Upon investigation, 55% of 286 patients enrolled in the Kaiser Permanente weight loss study acknowledged sexual abuse — an absolutely staggering statistic Felitti could hardly believe at first. Many of these patients also spoke about other childhood traumas.

Since these patients unconsciously used obesity as a defense mechanism, their weight loss efforts were often unsustainable, and they’d gain all the weight back. Since the publication of the 1998 ACE Study, Felitti and co-principal investigator Dr. Robert Anda have published more than 75 articles on its findings and other follow-up investigations.

The Importance of Sharing and Acceptance

Unfortunately, while interest in ACEs has grown, there’s been a strong resistance to using the information in clinical medical practice. For example, there were fears that questions about ACEs might enrage patients or trigger suicide.

However, when Felitti conducted an investigation, he found that when the ACE questions were included in an adult medical history intake, outpatient visits were actually reduced by 35% and emergency room visits declined by 11% in the subsequent year, compared to the year before the ACE questions were added.

They also found there was no rise in referrals to psychotherapy, so the reduction was not due to more people seeking psychiatric help. What they eventually discovered was that the mere ability to talk about their ACEs had a tremendously beneficial effect. Felitti writes:12

“We learned from patients that our apparent acceptance of them after hearing their dark secret was of profound importance. After lengthy consideration, we came to see that ‘Asking’ … followed up by face-to-face ‘Listening’ and ‘Accepting’ was a powerful form of ‘Doing.’

In other words, we had come upon a mechanism for reducing traumatic shame, which shame had the secondary effect of causing stress-related symptoms and hence doctor visits. Given our sample size, the economic implications of a reduction of this magnitude in medical utilization are in the multibillion-dollar range for any large organization.

Numerous legislatures, state and federal, have become involved because of the multibillion-dollar implications of the ACE Study findings for population health as well as medical care budgets.

The WHO has been collecting data annually with an International Version of the ACE Questionnaire in more than two dozen European and Asian nations, and the CDC has added since 2009 an ACE module to its annual Behavioral Risk Factor Surveillance Study, with almost all states currently participating.

Thus, in spite of the slow progress over the past 20 years, the international breadth and strength of interest in understanding the implications and extent of the ACE findings strongly suggest that our keynote AJPM article will ultimately have a major role in advancing well-being and medical care.”

Mind-Body Connection

In the two decades since the ACE Study came out, researchers have investigated the connection between childhood trauma and adult disease states from a variety of angles, looking for biological mechanisms to explain it.

One proposed mechanism involves the hypothalamic-pituitary-adrenal (HPA) axis, which controls stress reactions and regulates immune function, energy storage and expenditure, moods and emotions by way of hormones. A key hormone involved is cortisol, which plays a role in energy regulation. As explained by Piore:13

“When all is calm, the body builds muscle or bone and socks away excess calories for future consumption as fat, performs cellular regeneration and keeps its immune system strong to fight infection. In the case of a child, the body fuels normal mental and physical development.

In an emergency, however, all these processes get put on hold. The HPA axis floods the bloodstream with adrenaline and cortisol, which signals the body to kick into overdrive immediately. Blood sugar levels spike and the heart pumps harder to provide a fast boost in fuel …

When the emergency goes on for a long time — perhaps over an entire childhood of abuse — the resulting high levels of cortisol take a big and lasting toll.”

ACEs and Cortisol Dysregulation

Interestingly, researchers have discovered that different ACEs impact cortisol regulation in different ways. Children who experience severe emotional, physical or sexual abuse tend to have abnormally high cortisol levels first thing in the morning, while children experiencing severe neglect tend to have abnormally low morning levels.

Low morning cortisol has been linked to delinquency and alcohol use, while high morning cortisol levels are associated with anxiety, depression and post-traumatic stress disorder.

Excessive amounts of cortisol also lower immune function, thus raising the risk of infection, and raises the risk of high blood pressure, insulin resistance, Type 2 diabetes, obesity and heart disease.

On the other hand, too little cortisol increases the risk of an inflammatory immune response and exaggerated inflammatory response to stress. “Sickness behavior” — lack of appetite, fatigue, social withdrawal, depressed mood, irritability and poor cognitive functioning — has also been shown to be related to insufficient cortisol, Piore reports.

Genetics Also Play a Role

Researchers have also discovered that the presence of ACEs is in and of itself not enough to trigger toxic stress. Genetics also appear to play a role, as does interpersonal intervention. If someone is around to offer soothing reassurance, a sense of safety can be restored, allowing cortisol levels to normalize.

The problem is that chronic abuse is typically because no one is intervening on the child’s behalf. “Adversity and stress without adequate buffering can turn on genes that flood the system with enzymes that prime the body to respond to further stress by making it easier to produce adrenaline and reactivate the fight-or-flight response quickly, which can make it harder for children with toxic stress to control their emotions,” Piore notes.14

Childhood Trauma Is a Significant Health Risk

In 2019, the U.S. Centers for Disease Control and Prevention analyzed data from 144,017 individuals in 25 states, finding:15,16

  • Nearly 1 in 6 adults (15.6%) has experienced four or more types of ACEs
  • ACEs raise the risk of at least five of the top 10 leading causes of death
  • Preventing ACEs could reduce adult depression rates by as much as 44%, asthma rates by 24% and stroke by 15%
  • Preventing ACEs could also prevent up to 1.9 million cases of heart disease and up to 2.5 million cases of overweight or obesity

Interventions to Combat the Stress Response

The good news is that as the role of ACEs and toxic stress is becoming more widely recognized, doctors can begin to address these issues, which is what Harris is pushing for in California. Caregivers of stressed or traumatized children also need to be educated on the importance of emotional and physical buffering. Piore writes:17

“Buffering includes nurturing caregiving, but it can include simple steps like focusing on maintaining proper sleep, exercise and nutrition.

Mindfulness training, mental health services and an emphasis on developing healthy relationships are other interventions that Burke Harris says can help combat the stress response.

The specifics will vary on a case-by-case basis, and will rely on the judgment and creativity of the doctor to help adult caregivers design a plan to protect the child — and to help both those caregivers and high-risk adults receive social support services and interventions when necessary … ‘Most of our interventions are essentially reducing stress hormones, and ultimately changing our environment,’ says Burke Harris. "

A 2017 paper18 in Health & Justice delineates further “action steps using ACEs and trauma-informed care” to improve patient resiliency without retraumatizing them.

Resilience is the ability of your body to rapidly return to normal, physically and emotionally, after a stressful situation. One way to improve resilience is through breath work, as described in “Simple Techniques to Reduce Stress and Develop Greater Resiliency.”

The Health & Justice paper19 also highlights the importance of incorporating neuroscience concepts to trauma-informed care programs and therapies, and stresses the use of a resilience-oriented approach in order to move “from trauma information to neuroscience-based action with practical skills to build greater capacity for self-regulation and self-care in both service providers and clients.”

Problems and Challenges: ACE Score May Be Misleading

California’s Department of Health Care Services ACEs Aware Initiative kicked off January 1, 2020.20 Health care providers in the state are encouraged to screen patients for ACEs that might influence their health, and connecting patients in need with the appropriate interventions and resources.

Some, however, including Anda, who helped develop the ACE score with Felitti, worry that the ACE score might not work well when applied to individual patients, as it does not take into account caregiver buffering and other factors that tend to be protective. Piore writes:21

“The problem with applying it to individual patients, he says, is that it doesn't take into account the severity of the stressor. Who's to say, for instance, that someone with an ACE score of one who was beaten by a caregiver every day of their life is less prone to disease than someone with an ACE score of four who experienced these stressors only intermittently?

On a population level, surveying thousands, the outliers would cancel each other out. But on the individual level they could be misleading.”

While screening tools can indeed be misused and lead to inappropriate labeling, recognizing the influence of ACEs in public health is an important step forward. In coming years, we’re likely to see more advances in screening methods as well.

Source : Mercola More   

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