A GLUTEN FREE GROCERY PROGRAM FOR WOMEN’S MENTAL HEALTH AND
SEX/GENDER DIFFERENCES RESEARCH
AntoiDominique Nichole Pilar Vaccaro
B.S., California State University, Sacramento, 2005
PROJECT
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF ARTS
in
EDUCATION
(Special Education)
at
CALIFORNIA STATE UNIVERSITY, SACRAMENTO
FALL
2010
A GLUTEN FREE GROCERY PROGRAM FOR WOMEN’S MENTAL HEALTH
AND SEX GENDER DIFFERENCES RESEARCH
A Project
by
AntoiDominique Nichole Pilar Vaccaro
Approved by:
__________________________________, Committee Chair
Rachel Gonzales Ed.D.
_________________________
Date
ii
Student: AntoiDominique Nichole Pilar Vaccaro
I certify that this student has met the requirements for format contained in the University
format manual, and that this project is suitable for shelving in the Library and credit is to
be awarded for the Project.
_________________________, Graduate Coordinator ______________________
Bruce Ostertag Ed.D.
Date
Department of Special Education, Rehabilitation, School Psychology, & Deaf Studies
iii
Abstract
of
A GLUTEN FREE GROCERY PROGRAM FOR WOMEN’S MENTAL HEALTH
AND SEX/GENDER DIFFERNCES RESEARCH
by
AnotiDominique Nichole Pilar Vaccaro
This Women’s Mental Health and Sex/Gender Differences Research (R21) is
written to allow a one year study for women diagnosed with bipolar disorder and provide
the implementation of a Gluten Free Grocery Program (GFGP) to reduce the symptoms
and side effects of psychotropic medications associated with bipolar disorder as defined
by the DSM-IV. To address the problem of lack of adequate treatments and alternative
methods for women with bipolar disorder the implementation of a Gluten Free Grocery
Program, is to be administered for the course of one year in the San Francisco and East
Bay area. The goal is to allow women a choice to current psychotropic drugs that have
proven to be harmful and consistently cause severe side effects, which essentially stops
women from the use of any treatment. This program is aimed to increase the levels of
functionality of the participants both mentally and emotionally to regain more
functionality and life vitally.
_______________________, Committee Chair
Rachel Gonzales Ed.D.
_______________________
Date
iv
Dedication
This work is dedicated to my ancestors the red, white, brown, black, yellow and those
from other worlds. I want to acknowledge the depths of my multicultural background. It
has been an interesting journey of my spirit and soul to be an old soul time traveler in a
young soul world. To my Savage grandparents (George W. and Mamie) for my
aristocratic class level intellect, strength, showing and teaching me love. To my mother,
Juanita Savage-Boyd for offering the truth and not allowing anyone to assign me feelings.
To my Aunt Joyce A. Lee, for all the financial support. To my favorite cousin,
Christopher Michael Savage. But mostly, to my sister, best friend, fashion designer old
soul Quesstonnal Carmen Emanuelle Reed, I love you infinity. I could not have come this
far without you. Our gluten free lifestyle has lead to great health, and incredible wealth.
Also to Dr. Anthony Ramsey-Wallace, Dr. Todd Koch, Phil Hitchcock, Dr. Bernice Bass
de Martinez, Dr. Rachael Gonzales, Dr. Kaylene Richards-Ekeh for your assistance,
support and inspiration. Thanks, to the stardust from those celebrities who believe in me
and offer financial support. To my spirit guides for keeping me in belief and in practice
of magic. To anyone who I may have forgot that offered me positively energy. Lastly, to
my future husband and children (if any), you may manifest! I can close this chapter and
open a new one!
v
TABLE OF CONTENTS
Page
Dedication ..............................................................................................................................v
Chapter
1. INTRODUCTION…. ........................................................................................................ 1
Statement of the Problem………….………………………………………….. ............ 4
Purpose…………………………………………………………………………….... .. 5
Delimitations of the Project………………………………………………………….. 6
Definition of Terms…………………………………………………..……………..... 7
2. REVIEW OF THE LITERATURE ...................................................................................17
Specific Gender Needs for Women with Bipolar Disorder ..........................................18
Alternative Treatments to Psychiatric Medications ......................................................22
Study One......................................................................................................................28
Study Two .....................................................................................................................29
Study Three ...................................................................................................................29
Benefits of Gluten Free Diet for Women with Bipolar Disorder..................................30
Variables that Exacerbate Bipolar Disorder .................................................................30
Symptoms of Gluten Allergies......................................................................................31
Summary .......................................................................................................................32
vi
3. METHODOLOGY ............................................................................................................34
Request for Application ................................................................................................34
Description of a Model .................................................................................................34
Program Services ..........................................................................................................35
Program Staffing ..........................................................................................................36
Evaluations ....................................................................................................................36
Organizational Structure ...............................................................................................36
Summary .......................................................................................................................37
4. CONCLUSIONS................................................................................................................38
Summary .......................................................................................................................39
Recommendations .........................................................................................................39
5. RESOURCES FOR NATURAL ALTERNATIVES FOR HEALING .............................41
Appendix: A Gluten Free Grocery Program Grant for Women’s
Mental Health and Sex/Gender Differences Research...........................................................48
Gluten Free Grocery Program Grant for Women’s Mental Health and Sex/Gender
Differences Research .............................................................................................................49
Project Abstract .....................................................................................................................49
Problem Statement ................................................................................................................50
Target Population ...................................................................................................................50
Literature Review...................................................................................................................51
Goals and Objectives .............................................................................................................52
vii
Working Hypotheses ..............................................................................................................56
Methods, Strategies and Program Design ..............................................................................56
Evaluations .............................................................................................................................57
Objectives of the Evaluation ..................................................................................................57
Information Management System ..........................................................................................57
Impact Evaluation ..................................................................................................................58
Organizational Structure ........................................................................................................58
Project Management and Staffing ..........................................................................................58
Budget and Budget Justifications...........................................................................................60
References ..............................................................................................................................62
viii
1
Chapter 1
INTRODUCTION
The Problem
Bipolar disorder occurs with great frequency and spans the nation (National
Alliance of Mental Illness [NAMI], 2009). Approximately 12 million women in the
United States live with a diagnosis of bipolar disorder (National Mental Health
Association, 2005). The importance of this level of prevalence is obvious when one
considers that individuals diagnosed with a bipolar disorder may experience symptoms
including sluggishness, fatigue, exhaustion, feelings of hopeless or depression,
disturbances with appetite and sleep, confusion, uncontrollable crying, fear of harming
self, mood swings, racing thoughts and elevated moods (American Psychiatric
Association, 2006). Moreover, the symptoms of bipolar disorder can not only have
debilitating effects on a mother, but also on the well being of her children and family
(Stegler, 2008). For example, children of mothers diagnosed with bipolar disorder have
an increased likelihood of developing attachment disorders, behavior problems,
developmental delays, and health issues (Kroll, 2007).
In addition to the symptoms identified above, many women with bipolar disorders
suffer from allergies to food (Marohn, 2005). This is of importance because evidence
exists that food allergies may exacerbate bipolar symptoms (Marohn). The significance
of this problem with food allergies in the presence of a bipolar disorder is demonstrated
by research by Nambudripad Allergy Elimination Technique (NAET) practitioners who
2
have found that the elimination of allergies can in some cases reverse bipolar disorder
and other mental illness (Marohn).
Eliminating the effects of food allergies involves a twofold benefit for individuals
with mental illness (Hall, 2007). Removing the source of the allergy eliminates the acute
response/increase in symptoms. In addition, removal of the allergy-causing substance
tends to improve the individual’s digestion of the proper nutrients, thereby addressing
underlying deficiencies that exacerbate bipolar symptomatology (Hall).
Given the knowledge that food allergies can cause bipolar symptoms, it would
seem to be an obvious issue to address for people diagnosed with a bipolar disorder.
However, many times people are not aware of their allergies. The allergy goes
undetected and the chronic reaction begins to create energy blockage, which leads to
panoply of symptoms, including those of bipolar disorder, clinical depression, and
schizophrenia (Marohn, 2005). On the other hand, there exist documented nutritional,
diet alternative therapies that can be utilized when treating bipolar disorder (Truehope,
2005).
Providing adequate alternative treatment and accessible mental health services to
women with bipolar disorders in need of mental health services has been a challenge
(Null, 2003). Without more adequate and effective alternative mental health services
programs, families run the risk of destructive parent-child interaction, which impacts the
health and well being of children and increases the potential for child neglect and abuse
3
(Null, 2003). By assisting the population of women with bipolar disorders, we then may
affect the dynamic of the whole family unit in a positive manner (Null).
One food product to which some women are allergic is gluten. Gluten is difficult
to digest, and many people develop intolerance to it, this means the body regards it as a
foreign substance and because of this intolerance, the immune system launches an
immune reaction against gluten (Shepard, 2008). Moreover, as a result of this process,
allergies can produce mental and behavioral symptoms as gluten causes inflammation in
brain (Shepard).
Similarly, psychiatric medications can make psychotic symptoms worse and/or
increase the likelihood of having psychotic symptoms (Hall, 2007). Psychiatric
medications can change receptors for such neurotransmitters as dopamine, making a
person “increasing sensitive to psychotic behavior, also it can increase sensitivity to
emotions and experiences in general” (Hall). Some people with bipolar disorder report
their first psychotic symptoms occurred after starting to take psychiatric drugs (Hall).
In furtherance of the notion that the above-described issues are of importance, it
should be noted that mental illness is the second leading cause of disability and premature
mortality in the U.S and other developed countries (Marohn, 2005). In 2002, in the U.S
one in four hospital admissions were psychiatric patients (Marohn). A major reason why
treatments of mental disorder have had modest success is that the emphasis has been
placed on pharmaceuticals and not the use of alternative methods that have proven in the
past to be successful (Hall, 2007). Extreme mood swings occurring within a single day
may typify the patient with gluten allergy (Pfeiffer, 2007). These moods may be mania or
4
deep depression and can correspond with the ingestion of foods (Pfeiffer). If women
diagnosed with bipolar disorders are allergic to gluten products, paranoia and abnormal
thinking can occur within twenty-four hours of ingestion (Pfeiffer). Allergies can upset
levels of hormones and other key chemicals in the brain, resulting in symptoms ranging
from depression, bipolar disorder and schizophrenia (Pfeiffer).
Recognizing wheat-gluten sensitivity is frequently difficult. If the doctor (or
nutritionist) or the patient is even vaguely suspicious of gluten sensitivity, a special diet
can be undertaken for a trial period (Pfeiffer, 2007). Unfortunately, weeks or months may
be required before a marked improvement appears after wheat, gluten, rye, barley, and
oats are removed from the diet (Pfeiffer). Moreover, reintroduction of these grains into
the diet usually produces a relapse in months, or even hours. It is important, then to
maintain a strict adherence to the diet and to be aware of the exact ingredients of all foods
(Pfeiffer).
Statement of the Problem
The number of women in the United States diagnosed with Bipolar disorder is
estimated to be approximately 12 million (National Institute of Mental Health, 2009). The
primary treatment modality for women diagnosed with Bipolar Disorder is psychotropic
medication (Hall, 2007). However, it is estimated that 56% percent of these women do
not experience satisfactory control of their bipolar symptoms via the psychotropic
modality (Hall). In addition, it is estimated that approximately 39.3% of minority women
diagnosed with bipolar disorder live below the poverty level and are typically exposed to
much less nutritious and healthy options than others (Hall). Furthermore, it has been
5
suggested that a diet that lacks proper nutrition or which contains food allergens,
exacerbates psychiatric symptomatology (Marohn, 2008).
Purpose
This grant proposal is written to address the positive effects of a gluten free diet
on women diagnosed with bipolar disorders as defined in the DSM -IV. The results will
be recorded over the period one of year. The women’s mental health and sex/gender
differences research grant will bring alternative treatment to the unique and individual
needs of women in San Francisco, California. This study is based on testing of a panel
including allergies of gluten, wheat, sugar and other sensitivities to food that cause
bipolar symptoms or cause symptoms to be exacerbated. In America, methods that
include pharmaceuticals are the respected method to treat long term issues of bipolar
disorder (Hall, 2007). When patients express their concern over the negative effects of
the medications given to them for bipolar disorders, doctors, and/or government officials,
often ignore the evidence (Stanford, 2005). However, there is research based evidence
from other countries; including the United Kingdom, Sweden, and Canada as well as
evidence described by “an underground network” that individuals have benefited
immensely from natural remedies to treat the symptoms of bipolar disorder (True Hope,
2008).
The implementation of a gluten free diet for women diagnosed with bipolar
disorders will potentially have positive outcomes on unwanted symptoms of mental
illness. The gluten free diet treatment is intended to add more functionality, well being,
6
and emotional stability by removing the side effects related to the pharmaceuticals, and
by diminishing the symptoms of bipolar disorder. The grant shall create an option to the
negative side effects of prescription drugs that make women with bipolar disorders
experience negative personality changes, including not feeling themselves, feeling
drugged, emotional bluntness, diminished creativity, and reduced psychic/spiritual
openness (Hall, 2007). Approval of this grant will allow women with bipolar disorder,
who lack financial resources to provide themselves and their family with a gluten free
diet. By utilizing this alternative treatment, it is hoped that women with symptomatic
bipolar disorder can stabilize their home environment and thereby improve their
children’s overall health (Kroll, 2007). It was the hope of this writer that this grant would
be approved by the Women’s Mental Health and Sex/Gender Differences Research
Center and that an alternative gluten-free program would be started at The Earth Circles
Counseling Center in Berkeley California or/and Icarus Project and Freedom Center San
Francisco, California.
Delimitations of the Project
This project is written to benefit women with bipolar disorder as diagnosed by
using the criteria of the DSM-IV, and includes Bipolar I, Bipolar II, Major Depressive
Episodes, Manic Episodes, and Mixed Episodes. The subjects must be exhibiting
emotional symptoms associated with the bipolar disorder. The subjects in this study have
no age, religion or race restrictions. The subject must also voluntarily agree to abstain
from recreational drugs and alcohol for the course of the research project. The author of
7
this grant and project did not want to exclude any women with bipolar disorder who
needed or wanted to participate in a gluten free diet. However, the majority of the
subjects in the program will be selected based on a lack of financial ability to afford a
gluten free diet. In addition the subjects must live in the San Francisco, California or east
bay area. The subject must be naturally born female.
The data for this project is based on a comprehensive review of journal articles
and books. The compiling and writing of this grant proposal and chapters 1, 2, 3, and 4
were the sole task of this author. The grant was selected based on the need for programs
that would help women with bipolar disorder who are unable to afford a healthy
alternative gluten free diet.
Definition of Terms
Allergies. Abnormal immune reactions to substances that most people find harmless.
There are two categories of allergens: environmental (such as pollen, dust, molds, animal
dander, chemicals and cosmetics) and foods. Either category of allergens can trigger a
wide range of symptoms including depression, autism, bipolar disorder, schizophrenia,
migraines, seizures, arthritis, multiple sclerosis, chronic fatigue, major weight
fluctuations, skin and digestive ailments, and heart palpitations.
8
Bipolar I Disorder-Diagnostic Features
The essential feature of Bipolar I Disorder is a clinical course that is characterized by the
occurrence of one or more Manic Episodes or Mixed Episodes. Often individuals have
also had one or more Major Depressive Episodes or the presence of mania. Episodes of
Substance-Induced Mood Disorder (due to direct physiological effects of a medication,
other somatic treatments for depressive, a drug of abuse, or toxin exposure) or Mood
Disorder Due to General Medical Condition do not count toward a diagnosis of Bipolar I
disorder. In addition, the episodes are not better accounted for by Schizoaffective
Disorder and are not superimposed on Schizoaffective, Schizophreniform Disorder,
Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
Bipolar II Disorder- Diagnostic Features
The essential feature of Bipolar II Disorder is a clinical course that is characterized by the
occurrence of one or more Major Depressive Episodes accompanied by at least one
Hypomanic Episode. Hypomanic Episodes should not be confused with the several days
of euthymia that may follow remission of a Major Depressive Episode. Episodes of
Substance Induced Mood Disorder (due to the direct effects of a medication, or other
somatic treatments for depression, a drug of abuse, or toxin exposure) or Mood Disorder
Due to General Medical Condition do not count toward a diagnosis of Bipolar I Disorder.
In addition, the episodes are not better accounted for by Schizoaffective Disorder and are
not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or
Psychotic Disorder Not Otherwise Specified….
9
Criteria for Major Depressive Episodes
A.Five ( or more) of the following symptom have been present during the same two week
period and represent a change from previous functioning: at least one of the symptoms is
either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or
mood-incongruent delusions or hallucinations.
1. depressed mood most of the day, nearly everyday, as indicated by either subjective
report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful).
Note: In children and adolescents, can be irritable mood.
2. markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly everyday (as indicated by either subjective account or observation made
by others)
3. significant weight loss when not dieting or weight gain (e.g., a change of more than
5% of body weight in a month), or decrease or increase in appetite nearly every day.
Note: In children, consider failure to make expected weight gains.
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings or restlessness or being slowed down)
6. fatigue or loss of energy nearly every day
7. feeling of worthlessness or excessive or inappropriate guilt ( which may be
delusional) nearly every day (not merely self-reproach or guilt about being sick)
10
8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either
by subjective account or as observed by others)
9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or specific plan for committing suicide
A. The symptoms do not meet criteria for a Mixed Episode.
B. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
C. The symptoms are not due to the direct physiological effects of a substance (e.g.,
a drug of abuse, a medication) or a general medical condition (e.g.,
hypothyroidism).
D. The symptoms are not better accounted for by bereavement, i.e., after the loss of a
loved one, the symptoms persist for longer than two months or are characterized
by marked functional impairment, morbid preoccupation with worthlessness,
suicidal ideation, psychotic symptoms, or psychomotor retardation.
Criteria for Manic Episode
A. A distinct period of abnormally and persistently elevated, expansive , or
irritable mood, lasting at least a week (or any duration if hospitalization is
necessary).
B. During the period of mood disturbance, three (or more) of the following
symptoms have persisted (four if the mood is only irritable) and been present
to a significant degree:
11
1. inflated self esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only three hours of sleep)
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant
external stimuli)
6. increase in goal-directed activity (either socially, at work or school, or
sexually) or psychomotor agitation
7. excessive involvement in pleasurable activities that have a high potential for
painful consequences (e.g., engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments)
C. The symptoms don’t meet the criteria for a Mixed Episode.
D. The mood disturbance is sufficiently severe to cause a marked impairment in
occupational functioning or in unusual social activities or relationships with
others, or to necessitate hospitalization to prevent harm form self or others, or
there are psychotic features.
E. The symptoms are not due to the direct physiological effects of a substance
(e.g., hyperthyroidism).
Note: Manic-like episodes that are clearly caused by somatic antidepressant
treatment (e.g., medication, electroconvulsive therapy, light therapy) should not
count toward a diagnosis of Bipolar I Disorder.
12
Criteria for Mixed Episode
A. The criteria are met both for a Manic Episode and Major Depressive Episode
(except for duration) nearly every day during at least a 1 week period.
B. The mood disturbance is sufficiently severe to cause marked impairment in
occupational functioning or in usual social activities or relationships with
others, or to necessitate hospitalization to prevent harm to self or others, or
there are psychotic features.
C. The symptoms are not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication, or other treatment) or general medical
condition (e.g., by hyperthyroidism).
Criteria for Hypomanic Episode
A. A distinct period or persistently elevated, expansive, or irritable mood, lasting
throughout at least a 4 days, that is clearly different form usual nondepressed
mood.
B. During the period of the mood disturbance, three (or more) of the following
symptoms have persisted (four if the mood is only irritable) and have been
present to a significant degree.
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
13
5. distractibility (i.e., attention to easily drawn to unimportant or irrelevant
external stimuli)
6. increase in goal-directed activity (either socially, at work or school, or
sexually) or psychomotor agitation
7. excessive involvement in pleasurable activities that have a high potential for
painful consequences (e.g., engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments.
C. The episode is associated with an unequivocal change in functioning that is
uncharacteristic of the person when not symptomatic.
D. The disturbance in the mood and the change in functioning are observable by
others.
E. The episode is not severe enough to cause marked impairment in the social or
occupational functioning, or to necessitate hospitalization, and there are no
psychotic features.
F. The symptoms are not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication, or other treatment) or general medical
condition (e.g., hyperthyroidism).
Note: Hypomanic like episodes that are clearly caused by somatic antidepressant
treatment (e.g., medication, electroconvulsive therapy, and light therapy) should
not count toward a diagnosis of Bipolar II Disorder.
14
Gluten.
Gluten is a protein found in wheat, barley, rye, oats and other cereals grains, and which is
added to many commercial foods. Gluten is difficult to digest and many people develop
an intolerance to it, which means the body regards it as a foreign substance and the
immune system launches an immune reaction against it.
Gluten Intolerance.
Is a condition that requires adherence to a gluten- free diet but does not rise to the level of
an autoimmune disease. Food intolerances occur when the body is incapable of
metabolizing certain foods, typically because it lacks certain enzymes necessary to break
down particular food components. Individuals with gluten intolerance often have the
same overt symptoms as those with Celiac Disease (CD), but they test negative for celiac
disease by blood work and endoscopy. They learn through trial and error that gluten is a
cause for their uncomfortable symptoms and, once they adopt a gluten-free diet, live an
otherwise normal healthy life.
Nambudripads Allergy Elimination Techniques.
Also known as NAET, are non-invasive, drug free, natural solution to eliminate allergies
of all types and intensities using a blend of selective energy balancing, testing and
treatment procedures from acupuncture/acupressure, allopathy, chiropractic, nutritional,
15
and kinesiological disciples of medicine. Orthomolecular ecologic psychiatrists firmly
believe that foods, chemicals and inhalants in the environment affect human behavior.
R21 Mechanism.
R21 mechanism is intended to encourage new exploratory and developmental research
projects in biomedical informatics, biomedical information, and health sciences library
and information sciences. Theses studies may involve considerable risk but may lead to a
breakthrough in particular areas, or to the development of novel techniques, agents,
methodologies, models, or applications that could have major impact on a felid in
biomedical, behavioral, or clinical research.
Toximolecular Psychiatrists.
Those who use drugs or synthetic substances not normally found in the human body.
Organization of the remainder of the project
Chapter 2 will review the literature related to the following topics: specific gender
needs for women with bipolar disorder; alternative treatment to psychiatric drugs;
removing the use of psychiatric medications, research studies, benefits of gluten free diet
for women with bipolar disorder, bipolar disorder exacerbations, symptoms of gluten
allergy and summary.
16
Chapter 3 will describe the methods used to apply for the grant, a grant
description model, supporting research, program services, program staffing, program
evaluation and program continuation.
Chapter 4 will describe chapter conclusions, summary, and recommendations.
Chapter 5 will describe conclusions reached and give resources for alternative
healing, resources for gluten free programs, informative websites.
17
Chapter 2
REVIEW OF THE LITERATURE
The average American consumes one pound of chemical food additives per year
(Reiman, 2005). Speaking on the floor of the U.S Senate, Sen. Gaylord Nelson indicated
people are finally waking up to the fact that the average American daily diet is
substantially adulterated with unnecessary and poisonous chemicals and frequently filled
with neutral, nonnutritious substances. Nelson also declared, people are being chemically
medicated against their will and cheated of food value by low nutrition food standards
(Reiman). Beatrice Hunter (2006) has authored The Mirage of Safety, a catalog of the
possible dangers that lurk in the foods we eat. The Mirage of Safety, is a description of
how the Food and Drug Administration, through a combination of lax enforcement and
uncritical acceptance of the results of the food industry’s own “scientific” research has
allowed a situation to exist in which the American public is the real guinea pig for nearly
3,000 food additives (Hunter). As a result, American citizens are subjected to chemicals
strongly suspected of producing cancer, mental illness, gallbladder ailments and severe
allergies (Reiman). Americans also are exposed to other chemicals that inhibit
“mammalian cell growth” and may adversely affect the rate of DNA, RNA, and protein
synthesis and to similar chemicals that are capable of crossing the placental barrier
between mother and fetus and are suspected causes of birth defects and congenital
disease (Reiman).
During the 1980’s, American farmers used about eight million pounds of the
active ingredients in pesticides each year (Reiman, 2005). In 2003 farmers reported using
18
one billion pounds of chemical on crops each year (New York Times). Dr. Landrigan of
the Mount Sinia School of Medicine, writing in the 2002 issue of the American Journal of
Public Health, points to recent data from the US Environmental Protection Agency (EPA)
showing that infants and young children are permitted to have dietary exposures to
potentially carcinogenic and neurotoxin pesticides that exceed published standards by a
factor of more than 1000 (EPA, 2004). If these unnatural and dangerous chemicals are in
the food Americans consume, the effects to their neurological state must also be
considered as part of the underlying causes of mental disorders that have also steadily
risen over the years (Reiman). Landrigan (2002) also estimates three to 4 million
American preschool children have dangerously elevated blood lead levels, which could
result in long- term neuropsychological impairment.
According to the Diagnostic and Statistical Manual of Mental Disorders (2007), 4
out of 10 leading causes of disability in the US and other developed countries are mental
disorders. A recent report on mental health by the Surgeon General (2008) indicated
bipolar disorder ranked first among the top ten causes of worldwide disability. Mostly,
bipolar disorder goes undiagnosed and women visit physicians seeking other explanations
for their difficulties (Jonas and Brody).
Specific Gender Needs for Women with Bipolar Disorder
A gluten free program has been utilized at San Quentin State Prison for four
consecutive years. However, even with the success of the gluten free program at San
Quentin, it has only been implemented only on the male population (Hortiz, 2007). It is
19
imperative the female population diagnosed with bipolar disorder be included if such
research and case studies are this greatly beneficial. A growing number of psychiatrists
find reactions to foods and various chemicals to be common in different forms of
degenerative disease, and manifest in mental and/ or physical symptoms (Philpott &
Kalita 2000).
This suggests that the area of adverse reactions to food and additives is rapidly
expanding and becoming legitimized by a scientific base (Edelman, 2003). Most
antidepressants and other prescription drugs cause severe side effects, which usually
discourage patients from taking their medications (Lakhan & Vieira 2008). However, this
information is being ignored by both the medical and pharmaceutical communities
(Lakhan & Vieira, 2008).
England and Abery (2001) stated that, over the past 20 years, there has been a
change in family patterns, to include increased incidents of family violence and mental
illness, and a drastic increase in the number of women and children living in poverty. The
estimates of the percentage of marriages that will be dissolved and the percentage of
women and children that will spend some time in a single-parent family have surpassed
50% of the population (Heaton & Jacobson, 2004). A household that deals with bipolar
disorder has a massive affect on the whole family unit, but especially the children. A
major review article in the Australian and New Zealand Journal of Psychiatry, discussed
special considerations for women who have bipolar disorder. According to this article
gender differences differentiate diagnosis and treatment of bipolar disorder intended for
men and women (Barnes & Mitchell 2005). A woman’s metabolism is controlled by
20
hormones and these powerful chemicals play an important role in understanding bipolar
disorder in women (Barnes & Mitchell).
The following are highlights from Schizophrenia and Bipolar Education Day at
Stanford University on August 4, 2005, Bipolar I is equally prevalent among men and
women; Bipolar II (characterized by milder, ‘hypomanic’ episodes, but a greater burden
of depression) is more commonly reported in women. Women with bipolar disorder tend
to report more episodes of depression than men. Women also experience more ‘mixed’
episodes (episodes which have simultaneous features of both mania and depression.
Women are almost three times as likely as men to have a comorbid diagnosis. Two of the
most common comorbid disorders for women with bipolar disorder were alcoholism and
anxiety disorder. These combinations can trigger more frequent episodes.
Women with bipolar disorder are more likely to be rapid cyclers (experience four
or more episodes a year) than men (Barnes & Mitchell, 2007). Proposed explanations for
this include effects of gonadal steroids (estrogen or testosterone), hypothyroidism (more
common in women), and greater use of antidepressant medication in women, which has
been reported to cause episodes of mania in people with bipolar disorder. Also relative
are the effects that female hormones (menstrual cycle) can have on women with bipolar
disorder. Menstrual cycle hormones (fluctuation in estrogen and progesterone, which can
act on the activity of neurotransmitters serotonin, noradrenalin, and GABA) may
exacerbate bipolar symptoms in women. Two of the studies utilized at Schizophrenia and
Bipolar Education at Stanford University reported that 65% of women with bipolar
disorder reported worse mood symptoms during their menstrual cycle (Barnes &
21
Mitchell). Pregnancy can also bring hormonal changes that can exacerbate symptoms for
women with bipolar disorder.
Pregnancy represents a period of increased risk for women with bipolar disorder.
In one study, half of the women with bipolar disorder reported a worsening of their
symptoms during pregnancy (Barnes & Mitchell, 2007). The post partum period is also
recognized in this literature as a time of highly increased risk for an affective and/or
psychotic episode. Relapse rates for women with bipolar disorders within 3-6 months of
childbirth are reported to be as high as 67-82% (Barnes & Mitchell). Moreover, the risk
of psychosis increases from 10-20% in women with bipolar disorder during the post
partum period (Barnes & Mitchell).
Dr.Terence Ketter spoke about bipolar disorder at the Stanford University
Schizophrenia and Bipolar Education Day August 4, 2005, and acknowledged women
with bipolar disorder in the post-partum period are at highly increased risk for
experiencing a depressive episode. He also indicated “although the books won’t tell you
these things… in my clinical experience, women say it is the worst episode they have
ever had”. Women who become pregnant while taking prescription pharmaceuticals can
risk the lives and health of their unborn baby (Barnes & Mitchell, 2005). However, long
term studies have not been conducted to investigate the use of pharmaceuticals in
pregnancy. The results of such studies would be of greatest importance with respect to
the first trimester of a women’s pregnancy when the fetus’ major organs are being
formed. Studies of the effects of antipsychotics on women who breast feed have been
22
inclusive. Therefore, it seems safer to insure the healthiest baby by using alternative and
natural treatments that are not harmful to the mother or the fetus.
The issues described above are a few of the special needs that are important to the
research of gender differences and are specific to this grant proposal for women with
bipolar disorder.
Alternatives Treatments to Psychiatric Medications
There exist many different alternative treatments including vitamins, diets, herbs
and therapies that can be utilized when treating bipolar disorder (Marohn, 2005). The
True Hope treatment program uses a vitamin supplemental method (Marohn). Since
1966, scientific researchers and doctors at True Hope treatment program and other
clinical practices have been studying the effects of nutrients, diets and herbs for bipolar
disorder (Marohn).
Dr. Bonnie Kaplan, a behavioral research scientist and the principle researcher on
several of True Hopes studies indicated the normalization of mentally ill patients by
means of nutrient supplementation would be the most significant breakthrough in the
field of mental illness (True Hope, 2005). This women’s mental health and sex/gender
differences research grant will establish respectful communication with doctors and those
women with bipolar disorder who have an aversion to heavy sedation of psychotropic
medications and or allergies. Heavy prescription sedation is currently being encouraged
by the medical community though other treatments exist (Hall, 2007).
23
Effective therapeutic services exist that use a list of pharmaceutics and behavior
therapy (Stegler, 2004). Natural remedies or the application of a healthy diet, including
replacement of essential vitamins that contribute to the causes and symptoms of bipolar
disorder have also been proven effective (Kroll, 2007). However, these alternatives are
not included as options for impoverished women who face multiple barriers to access
alternative services and could benefit from natural medicine and allergy interventions
(Kroll).
In the United States alone, 30 million (1 in 10) people are now taking
Prozac, and the World Health Organization (WHO) predicts that by year 2020 depression
will be the single leading cause of death around the globe (Hall, 2007). It is important
that the challenge to support women with bipolar disorder from lower income levels be
addressed, in order for them to become healthier individuals better able contribute to
society (Hall). Many times alternative methods are not discussed with women who have
bipolar disorder who may wish to be introduced to other available treatments (Stengler,
2004).
Because psychiatric medications are a multi-billion dollar industry like big oil and
military spending, companies have incentives and means to cover facts about their
products (Hall, 2007). Companies actively suppress accurate assessments of drug risks,
mislead patients about how objective a mental disorder diagnosis is, promote a false
understanding of how psychiatric drugs really work, keep research into alternative
approaches unfunded and unpublicized, and obscure the role of trauma and oppression in
mental suffering (Hall). Individual approaches must be made to assist women with
24
bipolar disorder one method does not work for all women (Null, 2003). Many women
diagnosed with bipolar disorder complain about psychiatric medication side effects, yet
this is ignored within the medical community (Hall). With in the mental health system, it
has been “one size fits all” (Pfeiffer, 2007). Regardless of the human cost, scandals are
growing, and the fraud and corruption surrounding some psychiatric drugs are reaching
tobacco-industry proportions (Brody and Roper, 2003). Since the 1950’s, the treatment
of mental illness with drugs has become the major therapeutic tool of psychiatrists the
world over (Pfeiffer, 2005). The first antipsychotic drug, Reserpine, was introduced into
psychiatric practice in 1952, shortly followed by chlorpromazine (Thorazine) in 1954
(Pfeiffer). Drugs such as major tranquilizers should only be considered as temporary
crutches, to be used until the biochemical imbalances are slowly corrected by nutrient
therapy (Hall). Giving nutrients to neurological pathways could have long lasting
positive results that would lead to the removal for the need of sedative drugging (Philpott
& Kalita, 2000).
A problem which has been overlooked in the treatment of mental disorders until
recently is the discomfort to the patient resulting from side effects of some
psychotherapeutic drugs (Hall, 2007). Patients taking psychiatric medications may find
themselves unable to steady their hands (Hall). Other discomforts may include
involuntary facial muscle twitches and suicidal tendencies (Hall). Replenishing the body
nutrients is much different from psychiatric medications (Pfeiffer, 2007).
The nutritional approach to disease provides opportunities for objective
measurement, the necessary yardsticks for calculating the degree of impairment of the
25
body, and the slow gradual improvement, which occurs as the nutrients speed up normal
biochemical processes (Pfeiffer, 2007). The reason nutritional deficiencies are
widespread in society is because we consume monumental quantities of refined food and
many people suffer from unidentified food allergies (Reiman, 2005). Therefore, it can be
extremely beneficial to women diagnosed with bipolar disorder to follow a gluten free
diet. Gluten allergies can cause women with bipolar disorder to become more
symptomatic (Pfeiffer).
Allergy testing and financial support for gluten free groceries will be available in
San Francisco, California at the Icarus Project and Freedom Center and/or Earth Circles
Counseling Center. These supports will assist women with bipolar disorder to meet the
expense of the significant cost associated with assessing allergies and purchasing gluten
free diet products. In addition, counseling will be available during the weaning off
psychiatric medications. As described earlier, abstaining from recreational drugs and
alcohol is a prerequisite to be admitted into this gluten free grocery program. Significant
improvement to the overall health of women with bipolar disorder and emotional stability
during the course program is most likely to occur in the absence of recreational drug use.
Research suggests that, women with bipolar disorder, who use psychoactive drug
substances, are at increased risk for social stigma and negative consequences, including
the risk suicide or incarceration (Snow, 2008). The outcomes of treatment for women
with bipolar disorder will improve when both bipolar disorder and substance abuse are
addressed together (Snow). Snow, also found that patients with bipolar disorders who
develop substance abuse tend to have an earlier onset of bipolar disorder, than those who
26
develop substance abuse after the onset of bipolar disorder. Individuals who have both
bipolar disorder and substance abuse, regardless of which came first, make more suicide
attempts than do those with bipolar disorder without any substance abuse (Snow).
The author of this grant does not wish to subject the participants to any increased risk of
suicidal behavior. Any additional complications directly affecting women with bipolar
disorder participating in the gluten free grocery study program shall be responsibly
reduced. Women with bipolar disorder can react negatively to the use of recreational drug
and food allergies (Stengler, 2004).
Some women can have reactions to blood sugar or caffeine that gets mistaken for
psychosis or mental disorders (Hall, 2007). These types of reactions in the body can
threaten health, stability and sleep for people (Hall). Nutrition can play a huge role in
mental stability and better health (Pfeiffer, 2005). Exploring food allergies such as wheat,
gluten and milk can bring more vital nutrients back to the mind and body (Hall).
Toximolecular psychiatrists can sometimes manage to control psychiatric
symptoms of bipolar disorder (Philpott & Kalita, 2000). The underlying disease process
responsible for the symptoms in the first place often remains unchecked (Philpott &
Kalita). Many patients on drugs have to pay a high price for their symptomatic relief by
running the statistically high risk of becoming permanently incarcerated in their chemical
straightjackets (Philpott & Kalita). Dr. Robert Okin, former Commissioner of Mental
Health in Massachusetts, said, “Many patients who had been institutionalized for years
now find themselves living in low cost rooming houses, rocking in front of TV sets, and
27
wandering in the streets”. Many of these patients are being readmitted to mental
hospitals over and over (Okin, 2007).
At Sutter Center for Psychiatry in Sacramento, California a meeting is held for
people with bipolar disorder and those who support them. Meetings are once a month on
Thursday in the evening. During these meetings, many women with bipolar disorder
discuss openly their continuous readmittadance into the hospital despite their use of six to
10 pharmaceutical drugs prescribed by their doctors.
Research Studies
According to Lakham & Vieira (2008) many of the alternative studies including
gluten free diets and vitamin therapy for bipolar research were conducted in the 1970’s
and 1980’s, but were shut down due to underfunding. Nutritional therapies have now
become a long forgotten method of treatment, because they were of no interest to
pharmaceutical companies that could not fund patents or own them (Lakhan & Vieira).
Instead, the companies spent money investigating synthetics drugs they could patent and
sell; these drugs, however, cause severe adverse side effects (Lakhan & Vieira).
Other recent studies have indicated that gluten allergies may be responsible for
many cases of “bipolar disorder” and “schizophrenia” (Pfeiffer, 2005). One of the
earliest observations of the relationship between cereal grains and mental illness was
reported by Dr. Lauretta Bender in 1953, when she noted that children with schizophrenia
and bipolar disorder were extraordinarily subject to gluten free allergy. In the same year a
study by Graff and Handford published data stating that four of 37 adult males with
mental disorders admitted to the Institute of Pennsylvania Hospital, Philadelphia had a
28
history of gluten and wheat allergies in childhood (Graff & Handford, 1961). Therefore,
there are serious benefits to the health of women with children to use and maintain a
gluten free lifestyle (Philpott & Kalita, 2000).
According to Philpott & Kalita (2000), allergies to wheat and gluten stop the body
from processing the correct amount of protein and vitamins it needs to stay healthy. This
condition causes mental reactions that may closely mimic types of mental disorders. A
person cannot be deficient, toxic, or addicted to any food or chemical without suffering
the consequences of progression of the disease process onto a chronic degenerative
illness of some type”.
Study One
The importance of considering gluten sensitivity is well demonstrated in a study
by Dr. John Dohan (Casper, 2004). He randomly assigned all men admitted to a locked
psychiatric ward in a Veterans Administration Hospital in Coatesville, Pennsylvania, to
either a diet containing no milk or (wheat or gluten) cereals of a diet that was relatively
high in cereals. (Milk was eliminated from the diet because some people do not benefit
when only glutens are removed.) All other treatment remained as it had been. Midway
through the experiment 62 percent of the group on no milk and cereal were released to a
“full privileges” ward, while only 36 percent of those patients receiving a diet including
cereal were able to leave the locked ward. When the wheat gluten was secretly placed
back into the diet, the improved patients relapsed. Therefore, the study results suggested
that wheat- gluten sensitivity should be considered in the pathogenesis of the “bipolar and
29
schizophrenics,” and once diagnosis has been made, patients should understand and use a
diet free of any milk and gluten (Fabrega, 2008).
Study Two
A National Institute of Mental Health controlled study, of 34 women with
relatively normal estrogen, found non gluten intake improved mood 80% relieving earlymorning waking, loss of enjoyment, sadness and irritability (Schimdit, 2000). Menstrual
cycle effects include irritability, sadness, anxiety, insecurity, lethargy, tears, fatigue,
impatience, restlessness and tension. Nonetheless, suicide admissions increase just
before, and during menses. Affective psychosis is sometimes tied to menstrual cycle, and
may respond to appropriate hormones, a gluten free diet, and/or relevant nutrients in use
with other mood stabilizing therapy (Glick, Stewart, 2008).
Study Three
In Italy children are tested for wheat and gluten sensitivity by age seven
(Celiac.com). In the year 2000, a community based “CD-Watch” follow up program was
designed by the local Health Authority of the Brescia Province in Northern Italy. The
hope for the CD-Watch program was to increase awareness of gluten allergies and celiac
disease and to standardize diagnostic criteria for gluten intolerance and celiac disease
among health care professionals. Beginning in January 2003, all patients that reside in
the Province of Brescia have been enrolled in an ongoing CD-watch including gluten
allergies and follow up program. As a means of support the Italian government gives
30
patients a bonus to subsidize their gluten-free diet, and all the patients are required to
contact the Local Health Authority every year to renew their bonus.
Furthermore, the CD-Watch program requires all patients to have their blood
serum tested once a year for detection of certain antibodies. Testing for the antibodies
begins 12-16 months after a diagnosis. The testing is free of charge to the patients and
they can choose any laboratory they like. Results from the antibodies testing get reported
to the Local Health Authority, and it is a requirement to continue to receive subsidization,
although patients continue to receive subsidization regardless of their antibodies results.
Benefits of Gluten Free Diet for Women with Bipolar Disorder
Everyone can benefit from optimum nutrition. Moreover, food allergies can be
detrimental to mental and physical health (Frazier, 2009). Not everyone can digest wheat,
rye, and other cereal grains (Pfeiffer, 2007). Allergies to wheat and gluten cause food to
go into the gut undigested (Pfeiffer). Furthermore, alcohol and other recreational drug
use can increase depression in women with bipolar disorder (Snow, 2008). Therefore,
removing alcohol, in conjunction with a gluten free diet would be of most benefit.
Variables that Exacerbate Bipolar Disorder
A number of variables can exacerbate or contribute to bipolar disorder. These
contributing variables can include genetic vulnerability, stress, chemical toxicity, heavy
mental toxicity, food allergies, intestinal dysbiosis, sensitivity to food additives,
nutritional deficiencies or imbalances, neurotransmitter deficiencies or dysfunction,
31
hormonal imbalances, hypoglycemia, structural factors, medical conditions, medications,
stimulants, lack of sleep, lack of exercise, lack of light, energy imbalances, and
psychospiritual issues (Marohn, 2005).
The Gluten Free Grocery Program wants to commit to help reduce/remove the
symptoms that contribute to exacerbating or facilitating bipolar disorder by eliminating
gluten intake upon foods that contain gluten. There are many misconceptions about
foods that may or may not contain gluten. The ingredients in products are often hidden
within other names. Therefore, the individual must do extensive research to avoid foods
that contain gluten. Grains that contain gluten include wheat, spelt, kamut, teff, triticale,
semonlina, rye, oats, and barley (Marohn, 2005). Other foods/ substances that often
contain gluten include vinegar, delicatessen meats, bouillon, dextrin, caramel color, food
starch, hydrolyzed plant or vegetable protein, monosodium glutamate (MSG), malt, and
rice syrup, and natural and artificial flavorings (Marohn). There are many other foods and
substances that may contain gluten, including chewing gum, condiments, confectioner’s
sugar, envelope glue, frozen french fries, ice cream, medications, salad dressings, tomato
paste, tuna fish, and vitamins/mineral supplements (Marohn).
Symptoms of Gluten Allergies
There are numerous potential symptoms of allergic reaction to gluten including
the following anemia (low hemoglobin), autoimmune disorders such as rheumatoid
arthritis and lupus, behavioral changes (depression, irritability, failure to concentrate),
bloating and gas or abdominal pain distention, bone or joint pain, changes in appetite,
chronic diarrhea, colitis, collagen vascular disease, constipation, dermatitis herpetiformis
32
(burning, itchy, and blistering skin rash), delayed growth in children and delayed onset of
puberty, dizziness, easy bruising, failure to thrive in infancy, fatigue and lethargy,
fibromyalgia, hair loss, headaches, hypoglycemia (low blood sugar), hyposplenism,
increased risk of infections, infertility and miscarriage, iron deficiency, irregular or
speedy heartbeat, lactose intolerance, liver disease, lupus, lymphoma (cancer of lymph
glands), malnutrition, missed menstrual periods, mental fogginess, muscle cramps,
nausea and or vomiting, neurology problems (including schizophrenia, bipolar disorder,
ataxia, and epilepsy), nosebleeds, osteoporosis or osteopenia, pale, foul-smelling, bulky,
and/ or fatty stools that float, pale skin, seizures, short stature, shortness or breath,
Sjogren’s syndrome, intestinal cancers, thyroid disease (hyper- or hypothyroidism),
tingling or numbness in the hands and feet, tooth discoloration or dental enamel
defects/loss, type 1 diabetes, ulcers inside the mouth (aphthlous ulcers), vitamin or
mineral deficiency, and weight and loss/gain (Philpot & Kalita, 2000).
Summary
There are many factors to be considered and examined when starting a gluten free
diet and discontinuing psychiatric medications. Many women who are diagnosed with
bipolar disorders experience their first psychotic episode after taking the drugs (Hall,
2007)). Evidence shows that it is not impossible or harmful to consider the alternative to
the heavy sedation that occurs when psychiatric drugs are used (Hall). In addition, there
are no side effects of using a healthy gluten free diet. This alternative gluten- free diet is
especially appealing to those who have had to endure the harshness of the prescribed
33
psychotropic drugs or who stop taking them due to side effects. Every woman with
bipolar disorder is different. Alternative treatments for women with bipolar disorder who
do not receive significant benefit or relief from psychiatric drugs are a necessary
endeavor.
Psychiatric drugs do not treat the core problems or address the needs of the
individual as a person (Kilbourne, 2007). Women who are diagnosed with bipolar
disorders deserve to be treated fairly by the government and the medical community alike
(Hall, 2007). A woman with bipolar disorder needs to be allowed to exercise her options
for treatment. A doctor not respecting the choice or decision of a patient wanting to
remove psychiatric drugs is absurd and should not be tolerated (Hall). It is unethical for
the medical community to make decisions for women who have been diagnosed with
bipolar disorders without full disclosure of all available treatments. Bipolar disorder
symptoms can be subjective and there is not a scientific blood test to confirm diagnosis,
therefore, many women are misdiagnosed (Bourre, 2007). Hence, the requests of the
women diagnosed with bipolar disorder must be respected, so that she can have sufficient
support to resume the most beneficial existence (Edelman, 2003).
34
Chapter 3
METHODOLOGY
Request for Application
This grant is designed to provide an opportunity for patients diagnosed with
bipolar disorder to have access to a gluten free diet as an alternative to traditional
psychotropic medication. In addition, the grant seeks to reduce, diminish, and/or modify
the medication-based treatment and to offer a gluten free alternative for those women
suffering from serious side effects from psychotropic medications. The National Institute
of Health (NIH) seeks to foster the introduction of novel scientific ideas, model systems,
tools, agents, targets, and technologies that have the potential to substantially advance
biomedical research, by using the R21 mechanism. The R21 mechanism is intended to
encourage new exploratory and developmental research projects.
The Department of Health Services (DHS), including National Institutes of Health
(NIH) and National Institute of Mental Health (NIMH), are the organizations that offer
The Women’s Mental Health and Sex/Gender Differences Research Grant. Notification
of this grant is made through www.grants.gov. or by using CSUS, SMARTS output.
Description of a Model
The model description depicts the nature, goals and the requirements of the
Gluten Free Grocery Program. This writer also had to make sure to include and cite the
sources that were used in preparing this section of the grant. The Gluten Free Grocery
Program wishes to achieve saturation in qualitative research and identify all themes to
35
reduce the symptoms related to bipolar disorder. In addition this grant wished to
accomplish testing and the complete removal of gluten allergies. In addition, a individual
schedule for each participant to wean them off psychotropic medication will ensue. These
above described activities will take place to provide the highest level of functionality for
women diagnosed with bipolar disorder. There is no matching contribution at stake.
Because the nature and the scope of proposed research will vary from application to
application, it is anticipated that size and duration of each award will also vary. Costs
requested by consortium participants are not included in the direct cost limitation.
Finally, this writer had to locate where the Gluten Free Grocery Program would
be used in the San Francisco, California region. To her knowledge and research at the
current time, a program is not being utilized. In order to complete this section, this writer
used literature that was researched by various authors, journals and periodicals. She also
used information gathered by self research on a gluten free diet for over two years along
with another volunteer subject (Brooke Nelson) a woman with bipolar disorder at Sutter
Center for Psychiatry, to collect relevant information to create the conditions for a grantbased gluten free grocery program. The National Association of Mental Illness and
several other bipolar websites dedicated to bipolar disorder issues were used to validate
the severe need of alternatives choices to current treatments.
Program Services
This section of the program services includes descriptions of several different
elements. It begins with a project goal, description of direct activities and objectives for
36
women with bipolar disorder at the Icarus Project and Freedom Center where the Gluten
Free Grocery Program (GFGP) to be administrated. This program will include the
support in the removal of all participants’ psychiatric medications, testing of gluten
allergies, screening of street drugs/ alcohol, and the delivery of gluten free groceries. This
programs goal is to remove/ reduce the symptoms related to bipolar disorder and to
increase individual levels of functionality.
Program Staffing
The staffing of the Gluten Free Grocery Program will include the project
coordinator who will be responsible for the administration, management of the budget,
development and implementation of the program evaluation. The program coordinator
will also recruit from Icarus Project and Freedom Center and Earth Circles Counseling
Center. The on staff doctor will assist with the safe removal of psychotropic medication
and monitoring. A nurse will be utilized as support to the participants. A nutritionist will
ensure the removal of gluten from the participant’s diet. The driver will pick up and
deliver groceries to the participants as well as return data forms
Evaluations
This section describes methods that will be used for evaluating the effectiveness
of the program. It also describes how the evaluation will address the local issues and
concerns of the Gluten Free Grocery Program and its target design.
Organizational Structure
37
The organization of the project will include the direct support of The Icarus
Freedom Project Group and The Earth Circles Counseling Center. These centers will help
to provide counseling and support for the participants participating in the Gluten Free
Grocery Program. The total project period for an application submitted in response to this
funding opportunity may not exceed two years. The direct costs are limited to $275,000
over an R21 two-year period, with no more than $200,000 in direct costs allowed in any
single year. Once the financial commitment and grant approval is complete, the Icarus
Project and the Freedom Center and Earth Circles Counseling Center will assist to recruit
and address those chosen participants to receive the gluten free grocery benefits.
Participants, family members and any personnel involved in the program will be made
aware of the risks (symptoms and issues) concerning the reduction of or weaning off
psychiatric medications.
Summary
The Gluten Free Grocery Program is designed to develop individual functionality
by testing for allergies, and funding the cost of a gluten free diet that will facilitate
women with bipolar disorder to discontinue dangerous psychiatric medications. The grant
divides into nine parts, the problem statement, target population, goals and objectives,
literature review, methods, strategies and program design, evaluation, organizational
structure and the budget.
38
Chapter 4
CONCLUSIONS
The review of the literature substantiates the need for a Gluten Free Grocery
Program in the San Francisco, California area. According to Hall (2007), statistics have
shown that many women with bipolar disorder are interested in alterative treatments to
avoid the severe side effects of psychiatric drugs. To assist women with successful
adjustment, this writer recommends the program be implemented with assistance of The
Icarus Project and Freedom Center and the Earth Circles Counseling Center. This project
intention is to provide funding for a Gluten Free Grocery Program in collaboration with
the Icarus Project and Freedom Center and the Earth Circles Counseling Center. The
Women’s Mental Health and Sex/Gender Differences Research grant will utilize key
techniques such as allergy testing and nutrition diet therapy, to reduce the symptoms
those women who have been diagnosed with bipolar disorder experience. This reduction
or absence of symptoms can guide the women who participate in this program, to
experience more functionality and life vitality.
This reduction in symptoms can lead the participants in this program with improved
functionality to gain better employment and emotional stability. In addition, those women
diagnosed with bipolar disorder that stop taking psychiatric medications due to the harsh
side effects, could remain on a gluten free diet with out risk of severe side effects. This is
highly beneficial research because a continuous course of therapy would enable
participants to maintain a healthy form of advantageous treatment.
39
Summary
The purpose of this project is to produce a grant proposal for women with bipolar
disorder who would like to volunteer for an alternative treatment of bipolar disorder. This
writer realizes the need for such programs after herself using many different psychiatric
drugs to treat bipolar disorder. Over the course of several years of experiencing severe
allergic reactions, as well as negative attitudes from doctors opposing medication
alternatives the pursuit of an alternative treatment seemed warranted. Medical
professionals made the author feel that there were no other choices and they never offered
any alternatives to psychiatric medications. In addition, the author was exposed to many
women with bipolar disorder, who shared their personal experiences of wanting to
undertake alternatives to psychiatric drugs. Several other authors including Hall (2007),
Marohn (2007), Guyol (2006), and Null (2003) agree that alternative treatments to the
use of psychotropic medications are desirable to treat bipolar disorder.
Recommendations
It is imperative that women with bipolar disorder be tested for gluten allergies as
early as possible. Other recommendations are the following:
1) Full disclosure of the ingredients in food on the labels, to agreed upon by the Food and
Drug Administration. The American government has to be required to create a standard
healthy diet system without the use of artificial ingredients and pesticides. Corporations
should be completely regulated by the consumers. Corporations must not be able to earn
soaring profits by using artificial food ingredients and allowing unnecessary chemicals to
40
be added in the food. Producing a healthy source of available food options for Americans
to have balanced diets should be mandatory.
2) Awareness of food ingredients/ additives
Adequate diagnosis, allergy testing, improvement of the diet, and treatment with specific
nutrients is the first step toward a more effective and tolerable treatment of individuals
diagnosed with bipolar disorder.
3) Educate physicians, psychiatrists and psychologists regarding alternative treatment for
bipolar disorders.
4) Additional benefits that may facilitate those women diagnosed with bipolar disorder
reduce psychotropic medications and access alternative resource include requiring
vending machines to include gluten free alternatives, 75% of television commercials to
show food choices with natural ingredients, 30% of billboards to include unaltered
natural healthy foods, making alternative medicine disclosure required by law as an
option to psychotropic drugs, remove, drug advertising in the public, concentrate on
better relations between patients and doctors, provide more education to the
hospital/clinic staff, limit large discrepancies between scientific understanding and
clinical use of medications, adequately diagnose gluten allergies, utilize clinical
evaluation and dietary counseling and provide free mental health care and allergy testing
to those women with bipolar disorder that need or want it.
41
Chapter 5
RESOURCES FOR NATURAL ALTERNATIVES FOR HEALING
Referral Organizations
American Association of Naturopathic Physicians
4435 Wisconsin Avenue, NW Suite 403
Washington, DC 20026
(202) 237-8150
(866) 538-2267 toll free
www.naturalpathic.org with search referral system
In addition to basic medical sciences and convention diagnosis, naturopathic physicians
(N.D.s) are the highest trained practitioners in the broad scope of alternative medicine.
Alternative medicine includes therapeutic nutrition, botanical medicine, homeopathy,
natural childbirth, classical Chinese medicine, hydrotherapy, naturopathic manipulative
therapy, pharmacology, and minor surgery.
American College for the Advancement of Medicine (ACAM)
23121 Verdugo Drive, Suite 204
Laguna Hills, CA 92653
(949) 583-7666
(800) 532-3688 toll free
www.acam.org with search/referral system
42
ACAM is the largest and oldest nonprofit medical society dedicated to educating
physicians and other health care professionals on the latest findings and emerging
procedures in preventive/nutritional (alternative) medicine.
EEG institute
22020 Clarendon Street, #305
Woodland Hills, CA 91367
(818) 373-1334
www.eeginfo.com with search/referral system
The EEG Institute is the clinic and research center of the Brian Othmer Foundation, a
nonprofit agency dedicated to research, education and clinical services in neurofeedback.
National Center for Homeopathy
801 North Fairfax Street, Suite 306
Alexandria, VA 22314
(703) 548-7790
www.homeopathic.org with search/referral system
NCH is the leading open-membership organization supporting and promoting
homeopathy in the U.S.
43
Safe Harbor
787 West Woodbury Road, #2
Altadena, Ca 91001
(626) 791-7868
www.alternativementalhealth.com with search/referral system
A nonprofit agency educating the public, medical practitioners, and the government about
safe alternative mental health treatments. Seminars meet the requirements of the
Accreditation Council for Continuing Medical Education.
Well Mind Association of Greater Washington
P.O Box 201
Kensington, MD 20895
(301) 774-6617
Well Mind Association of Greater Washington is a nonprofit clearinghouse for
alternative mental health informational and referrals.
Resources: Celiac Disease, Gluten Free Programs and Specialists
University of Chicago Celiac Disease program
http://www.uschospitals.edu/specialites/celiac/index.php
Dr. Stefanno Guandalini www.celiacdisease.net
Director: Michelle Merlin-Rogovin 773-702-7593
44
Children’s Digestive Health Center
Dr. Joseph Levy, M.D.
3959 Broadway BHN-726
New York, NY 10032
212-305-5693
University of Maryland Center for Celiac Research
Dr. Alesio Fasano, M.D. Director Pam King
20 Penn Street, Room S303B
Baltimore, MD 21201
410-328-6749 or 1800-492-5538 www.celiachealth.org or www.celiaccenter.org
Dr. John J. Zone, M.D
Department of Dermatology
4B454 School of Medicine
30 North 1900 East
Salt Lake City, UT 84132-2409
Appointments: 801-581-2955
Office: 801-581-6465
45
Dr. Cynthia Rudert, M.D.
5555 Peachtree Dunwoody Rd.
Suite 312
Alanta, Ga 30342
404-943-9820
National Institute for Diabetes and Digestive and Kidney Disease (National Institute of
Health, NIH)
http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/
Resources for: Gluten Free Diet Support Organizations and Publications
Celiac Sprue association (CSA)
www.csaceliacs.org
P.O Box 31700
Omahara, NE 68131-0700
Toll free: 877-CSA-CSA-4CSA
Fax: 402-558-1347
Email: celiacs@csaceliacs.org
46
Gluten Intolerance Group (GIG)
www.gluten.net
15110 10th Ave SW Suite A
Seattle, WA 98166
Phone: 206-246-6652
Fax 206-246-6531
info@gluten.net
The Celiac Disease Foundation
www.celiac.org
13251 Ventura Blvd#1
Studio, City, Ca 91604
Phone: 818-990-2354
Fax: 818-990-2379
Email: cdf@celiac.org
Resources: Support Magazines
Living without
(www.livingwithout.com)
Gluten Free Living,
(www.glutenfreeliving.com)
47
GIG Quarterly Newsmagazine
(www.gluten.net)
Lifeline-CSA (www.csaceliacs.org)
Scott Free Newsletter
(www.celiac.com)
Informative Resource Web Sites
www.enterolab.com
www.breakintheviciouscycle.info
www.clanthompson.com
www.glutenfreedon.net
www.celiac.com
www.glutenfreemall.com
www.mercola.com
www.glutenfreerestaurants.org
www.GFlinks.com
www.GFCFdiet.com
www.foodintol.com
www.glutensensitivity.com
www.greenpeople.com
48
APPENDIX
A Gluten Free Grocery Program Grant for Women’s Mental Health and Sex/Gender
Differences Research
49
Gluten Free Grocery Program Grant for Women’s Mental Health and Sex/Gender
Differences Research
Project Abstract
This Women’s Mental Health and Sex/Gender Differences Research (R21) is
written to allow a one year study for women diagnosed with bipolar disorder and provide
the implementation of a Gluten Free Grocery Program (GFGP) to reduce the symptoms
and side effects of psychotropic medications associated with bipolar disorder as defined
by the DSM-IV. To address the problem of lack of adequate treatments and alternative
methods for women with bipolar disorder the implementation of a Gluten Free Grocery
Program will be administered for the course of one year in the San Francisco and East
Bay area. The goal is to allow women a choice/option to current psychotropic drugs that
have been proven harmful and have consistently caused severe side effects, which
essentially stops those women from experiencing any level of recovery from symptoms.
The goal of the Gluten Free Grocery Program is aimed to remove psychotropic
medications and introduce a side effect free, gluten free diet. This grant’s endeavor is to
increase the levels of functionality of the participants mentally and emotionally, which
will allow them to regain more life vitally.
50
Problem Statement
The number of women in the United States diagnosed with Bipolar disorder is estimated
to be approximately 2.5 million (National Institute of Mental Health, 2009). The primary
treatment modality for women diagnosed with Bipolar Disorder is psychotropic
medication (Hall, 2007). However, it is estimated that 56% percent of these women
diagnosed with bipolar disorder live below the poverty level and are typically exposed to
much less nutritious and healthy option then others (Hall, 2007). Furthermore, it has been
suggested that a diet that lacks proper nutrition or which contains food allergens,
exacerbates psychiatric symptomatology (Marohn, 2008).
Target Population
This project is written for the benefit and recruitment of women with bipolar disorder as
diagnosed by using the criteria of the DSM-IV, and includes Bipolar I, Bipolar II, Major
Depressive Episodes, Manic Episodes, and Mixed Episodes. The subjects must be
exhibiting emotional symptoms associated with the bipolar disorder. The subjects in this
study have no age, religion or race restrictions. The subject must also voluntarily agree to
abstain from recreational drugs and alcohol for the course of the research project. The
author of this grant and project did not want to exclude any women with bipolar disorder
who needed or wanted to participate in a gluten free diet. However, the majority of the
subjects in the program will be selected based on a lack of financial ability to afford a
gluten free diet. In addition, the subjects must live in the San Francisco, California or east
bay area. The subject’s must be naturally born female. In addition, the consumption of
sugar products will be greatly monitored and or reduced.
51
Literature Review
A gluten free program has been utilized at San Quentin State Prison for four
consecutive years. However, even with the success of the gluten free program at San
Quentin, it has been implemented only on the male population (Hortiz, 2007). It is
imperative the female population diagnosed with bipolar disorder be included if such
research and case studies are to be beneficial. A growing number of psychiatrists find
reactions to foods and various chemicals to be common in different forms of degenerative
disease, and manifest in mental and/ or physical symptoms (Philpott, 2000).
This suggests that the area of adverse reactions to food and additives is rapidly
expanding and becoming legitimized by a scientific base (Edelman, 2003). Most
antidepressants and other prescription drugs cause severe side effects, which usually
discourage patients from taking their medications (Lakhan & Vieira 2008).
There are great gender differences to differentiate diagnosis and treatment of
bipolar disorder intended for men and women (Philpott, 2000). A women’s metabolism is
controlled by hormones and these powerful chemicals play an important role in
understanding bipolar disorder related women (Philpott).
The following are highlights from Schizophrenia and Bipolar Education Day
Stanford University on August 4, 2005, Bipolar I is equally prevalent among men and
women; bipolar II (characterized by milder, ‘hypomanic’ episodes, but a greater burden
of depression) is more commonly reported in women. Women with bipolar disorder tend
to report more episodes of depression than men. Women also experience more ‘mixed’
episodes (episodes which have simultaneous features of both mania and depression.
52
Women are almost three times as likely as men to have a comorbid diagnosis.
The effects that female hormones (menstrual cycle) can have on women with
bipolar disorder. Menstrual cycle hormones (fluctuation in estrogen and progesterone,
which can act on the activity of neurotransmitters serotonin, noradrenalin, and GABA)
may exacerbate bipolar symptoms in women. Two of the studies utilized at
Schizophrenia and Bipolar Education at Stanford University reported that 65% of women
with bipolar disorder reported worse mood symptoms during their menstrual cycle.
Pregnancy can also bring hormonal changes that can exacerbate symptoms for women
with bipolar disorder. The issues described above are a few of the special needs that are
important to the research of gender differences and are specific to this grant proposal for
women with bipolar disorder.
This Women’s Mental Health and Sex/Gender Differences Research Grant would allow a
one year study with women with bipolar disorder with the implementation of a Gluten
Free Grocery Program (GFGP) this research study will be established in the San
Francisco and East bay area in agreement with, The Earth Circles Counseling Center in
Berkeley, California and The Icarus Freedom Project group in San Francisco, California.
Goals and Objectives
The purpose of the Women’s Mental Health and Sex/gender Differences Research
Grant is to demonstrate sex differences in hormone actions contribute to the differences
in physiological and behavioral responses to stress relevant to cognitive and emotional
regulation and mental disorders. The Gluten Free Grocery Program (GFGP) rationale is
in provide alternative treatments to psychotropic medications to women with potential
53
gluten (food) allergies and that have been diagnosed with bipolar disorder as defined by
the DSM-IV. This proposal is written to increase the understanding and provide
quantitative and qualitative data on the specific gender differences of women’s needs that
have been diagnosed with bipolar disorder.
The Gluten Free Grocery Program will provide a safe and tolerable treatment to
psychiatric medications and seeks to eliminate and reduce the symptoms associated with
bipolar disorder in women. The base of this research is to, start the implementation of a
Gluten Free Grocery Program (GFGP) combined with testing for the detection of any
related allergies. There will be additional drug testing to eliminate the presence outside
drug use to ensure the absence of street drugs, alcohol and the intake of sugar for the
duration of the program. The Gluten Free Grocery Program will offer a nutritious gluten
free diet as an alternative to pharmaceutical drugs for women diagnosed with bipolar
disorder at no cost to the participants. The program will include support in the removal
and reduction levels of all the participants’ psychiatric medications. Free Access to
testing for allergy panel will also be a part of the program. This alternative treatment
method will be used to measure the quality of life and record data of frequency of the
recurring symptoms associated with women diagnosed with bipolar disorder.
Project Goal:
The Gluten Free Grocery Program wishes to achieve saturation in qualitative research
and have all themes identified to assist with achieving the greatest decrease in bipolar
symptoms
54
Objective 1
Testing and removal of gluten food allergies
Activities:
1.1 Organize the volunteer recruitment of twenty women that have been diagnosed with
bipolar disorder at The Earth Circles Counseling Center in Berkeley, California
and/or The Icarus Project and Freedom Center in San Francisco, California. Nurses
and staff will provide an hour presentation about information and the requirements of
the Gluten Free Grocery Program and at that time ask that the participants sign
consent forms to be considered for the program.
1.2 Appointments will be scheduled to test for gluten food allergies in a concession of
intervals per the participant.
Objective 2
The reduction and removal of psychotropic drugs
Activities:
2.1 A presentation for the removal of psychotic drugs will also be scheduled. The
participants are asked to bring a list of current medications and prescription bottles to our
staff doctor. The individual participants and the medical doctor will map out the correct
removal /weaning off psychotropic medications. A drug screening for street drugs,
alcohol and sugar levels will be a mandatory component of the program participants, and
the will be required to be tested in 30 day intervals.
Objective 3
55
Target a decrease in the symptoms associated with women diagnosed with bipolar
disorder by delivering gluten free groceries one time a week, after psychotropic
medications have been removed. In addition, ask that participants continuingly journal
their experiences.
Activities:
3.1 Using bipolar disorder symptoms as described by DSM-VI assemble a qualitative
(interpretive research) survey to be collected by grocery driver and be required before
groceries are received.
3.2 To conduct a written passage summarizing the findings of the data analysis in a
narrative discussion using qualitative research on the intensity or lack of (intensity) of
bipolar symptoms. These data report forms will be picked up by the driver when
groceries are delivered. The program coordinator will keep track of the forms to analyze
the observations of symptoms reported by the participants. The purpose is to develop
multiple perspectives.
3.3 The data reports must be filled out each week or participants will not receive
groceries. Drivers deliver groceries to participants every week.
Objective 4
Increase individual level of functionality
Activities:
4.1 Have participants fill out a list of personal hobbies, chores, responsibilities, grooming
and socializing activities that they would like to do each day but cannot manage, because
of the severity of symptoms of bipolar disorder. Require a weekly report log of
56
qualitative data literature to set up relationships between the variables each day of the
activities they were able to perform successfully on a scale component from 1-10.
4.2 Report level of satisfaction at being able to participate in activities and
Working Hypotheses
1) Women diagnosed with bipolar disorder that are successfully tested for allergies,
can reduce the symptoms associated with the illness if they are administered a
gluten free diet.
2) The absence of the severe symptoms of bipolar disorder will allow the women
diagnosed with bipolar disorder to experience more functionality in her everyday
lifestyle.
Methods, Strategies and Program Design
The goal that is to be achieved is a one year study of women with bipolar disorder
on a gluten free diet that would dramatically reduce the symptoms in accordance with the
DSM -VI symptoms. The approach will be used to collect both quantitative and
qualitative data relative to any changes that are observed by the patient from selfreporting to the liaison and observation made directly by the doctor or nurse. The
proposed project aims to reduce the need for the long-term drug pharmaceuticals and
their severe side effects by the removal of the patient’s dependence upon them. In
addition, testing for allergies and adding gluten free diet for the course of 1year. The
gluten free grocery program is specific to women who met the DSM -IV criteria of
Bipolar disorder including Bipolar I, Bipolar II, Manic Depressive Episodes, Mixed
Episodes, and Hypomanic Episodes.
57
There is no age, or culture specification. The target population would include
female gender; and have a documented diagnosis of bipolar disorder in addition to
lacking the financial ability to afford a gluten free diet. The staff will assist with
supportive needs for the women diagnosed with bipolar disorder in the Gluten Free
Grocery Program. The setting would be conducted at the Icarus project group and/or The
Earth Circles Counseling Center in Berkeley, California. The intensity and frequency of
the Gluten free Grocery Program is as follows: groceries will be picked up and delivered
once a week, reporting will occur a once week (liaison will contact patient at home if
needed for reporting), the patient will also be required to met with the physician once a
month or nurse once a month for first 6 months.
Evaluations
The evaluation impact of the Gluten Free Grocery Program is to allow women
diagnosed with bipolar disorder who are participants, to experience an alternative
treatment and aid them in removal of psychotropic medications that can exacerbate the
symptoms and cause severe side effects associated with the disorder.
Objectives of the Evaluation
1) test and remove gluten foods that cause may allergies
2) decrease the symptoms associated with bipolar disorder
3) increase individual level of functionality (mental and emotional)
Information Management System
The Statistical Package for the Social Science (SPSS) program will be utilized to
enter data collected from the quantitative measurement tools developed by the Icarus
58
Freedom Project Group and The Earth Circles Counseling Center. The tools will measure
self reported bipolar symptoms and medical staff reported bipolar symptoms. Qualitative
data will be reported collected through participant logs, progress journals, interviews, and
consulting group meeting notes. All data will be complied and formatted the project
coordinator.
Impact Evaluation
The program coordinator will access the project objectives through the process
and outcome evaluation tests from pre and post test, surveys, and data collected
throughout the one year program. This data will be compiled into an evaluation report
that will demonstrate the impact of the program on the target populations
Organizational Structure
The Icarus Freedom Project Group and The Earth Circles Counseling Center are
dedicated to improving the lives of diverse individuals and families throughout the east
bay area in California. These centers provide counseling and support services for
individuals diagnosed with bipolar disorder.
Project Management and Staffing
The Gluten Free Grocery Program (GFGP) will consist of one project coordinator.
The project coordinator will be responsible for the administration and management of the
program budget, development and implementation of the program evaluation. The budget
will include travel to doctor’s appointments, gluten free reporting, allergy tests, and price
of monthly groceries. The physician will be responsible for the up to the first six month
of reporting, during the process of participants weaning off psychotropic drugs. The part-
59
time nurse will be utilized to assist the physician with reporting. However, the nurse will
be included for the entire twelve months of the study, to ensure the safety of the
participants. One part- time nutritionist will collaborate with the participants in grocery
selection and allergies maintenance. A full time delivery driver will pick up groceries,
deliver them to participants and return self-reporting data reporting forms.
60
Budget and Budget Justification
A. Personnel
Program Coordinator
Doctor
Nurse
Nutritionist
Delivery Driver
Twelve Month Total
Annual Salary FTE
Months Cost
Subtotal
$57,000
$1,500
$14,500
$5,400
$6,500
12
6
12
9
6
$57,000
$1,500
$14,500
$5,400
$15,000
$93,400
1.0
.0625
.0625
.0625
1.0
$57,000
$1,500
$14,500
$5,400
$15,000
B. Benefits (25% of Personnel Costs)
1. Payroll Taxes
2. Employee Benefits
a. Medical Benefits
b. Dental Benefits
c. Life Insurance
d. Worker’s Compensation Insurance
e. Others
Twelve Month Total
$23,350
C. Indirect Costs
$5,000
D. Travel
1. Local (Mileage)
a. Monthly Mileage (200 miles)
b. Number of Work Months (6 months)
c. Reimbursement Rate ($.55/mile)
$660
$5,000
Twelve Month Total
E. Equipment
1. Telephones: purchase, installation, wiring ($50 x 10) $500
2. Personal Computers
$2,500
3. Printer
$400
$660
Twelve Month Total
F. Office Materials and Supplies
1. General Office Supplies (&400 x 12)
2. Volunteer Recruitment materials
3. Postage ($60/month x 12)
$3,400
Twelve Month Total
$4,800
$1,000
$720
$6,520
61
G. Program Costs
1. Gluten Free Groceries
2. Allergy Lab Tests
3. Drug Tests
Twelve Month Total
H. Contractual/Consultants
Not Applicable
I.
$48,000
$10,000
$5,000
$63,000
Construction
Not Applicable
J. Office Space
($5000/month x 12 months = $60,000)
Twelve Month Total
$60,000
K. Others
Not Applicable
Annual Budget Subtotal
$255,330
Total Requested Budget
$195,330
62
REFERENCES
Barnes, C., & Mitchell, P. (2005). Considerations in the management of bipolar
disorder in women. Australian and New Zealand Journal of Psychiatry, 39(8),
662-673.
Bourre, J. (2005). Dietary omega-3 fatty acids and psychiatry: mood, behavior, stress
depression, dementia and aging. The Journal of Nutrition, Health and Aging, 9,
31-39.
Casper, R. (2004). Nutrients, neurodevelopment, and mood. Current Psychiatry Reports,
6:425-429.
Edelman, Eva. (2003). Natural Healing for Bipolar disorder: a compendium of
Nutritional approaches. Eugene, OR Borage Books.
CAL/EPA.gov (Environmental Protection Agency California).
Fabrega, H. (2008). On the postmodern critique and reformation of psychiatry: moving
beyond prozac, DSM and the new psychiatry. Psychiatry 71(2) Summer 2008:
183-196.
Frazier, E., Fristad, M., & Arnold, E. (2009). Multinutrient supplement as treatment:
literature review and case report of a 12 year old boy with bipolar disorder.
Journal of Child and Adolescent Psychopharmacology. 19, 453-460. doi:
10.1089/Cap.2008.0157.
63
Graff, H., Handford, A. (1961). Celiac syndrome in the case histories of five.
schizophrenics and manic depressives. Philadelphia, Penn. Institute of
Pennsylvania Hospital.
Guyol, G. (2006). Healing depression & bipolar disorder without drugs. New York, NY.
The Walter Company.
Hall, Will., Bergman, C. (2007). Harm reduction guide to: Coming off psychiatry. The
New York, NY: The Icarus Project and Freedom Center.
Horwitz, A., & Wakefield, J. (2007). The loss of sadness: how psychiatry transformed
normal sorrow into depressive disorder. Oxford Press.
Hunter, B. (1982). The mirage of safety: food additives and federal policy. New York
NY: Penguin.
Icarus Project and Freedom Center (2007) Navigating the space between brilliance
and madness: a reader road map of bipolar worlds.
Jonas, B., Brody, D., Roper, M., & Narrow, W. (2003). Prevalence of mood disorders
in a national sample of young American adults. Social Psychiatry Epidemiol, 38,
618-624. doi: 10.1007/s0003-0682-8
Kilbourne, A., Rofey, D., McCarthy, J., Post, E., Welsh, D., & Blow, F. (2007).
Nutrition and exercise behavior among patients with bipolar disorder. Bipolar Disorders.
9, 443-452.
Kroll, K. (2007). New directions in the conceptualization of psychotic disorders. Current
Opinion Psychiatry, 20, 573-577.
64
Lakhan, S., & Vieira, K. (2008). Nutritional therapies for mental disorders.
Nutritional Journal, 7(2), 1-8.
Ludvigsson, J., Reutfors, J., Osby, U., Ekbom, A., & Montgomery, S. (2007). Coeliac
Disease and risk of mood disorder-a general population-based cohort study.
Journal of Affective Disorders, 9(9) 117-126. doi: 10.1016.jad.2006.08.032.
Manand, L. (2010). Head case- can psychiatry be a science? The New Yorker: March:
68-74.
Marohn, S. (2005). The natural medicine guide to: bipolar disorder. Charlottesville,
VA: Hampton Roads
Null, G. (2003). The complete encyclopedia of natural healing: a comprehensive
a-z listing of common and chronic illnesses and their proven natural treatments.
Stamford, CT: Kensington Books
Pfeiffer, C. (2007). Nutrition and mental illness: an orthomolecular approach to
Balancing body chemistry. Rochester, VT. Harper & Row.
Philpott, W., & Kalita, D. (2000). Brain Allergies: the psychonutrient and magnetic
Connections. Los Angeles, CA. McGraw-Hill.
Reiman, J. (2005). The rich get richer the poor get prison: ideology, class and criminal
justice. Washington, DC. Allyn & Bacon.
Shepard, J., (2008). The first year celiac disease and living gluten free: an essential
guide for the newly diagnosed. Philadelphia, PA. DeCapo Press.
Schizophrenia and Bipolar Education Day (2005, August 5). Stanford University.
Stanford University. Palto Alto, CA.
65
Snow, D., Smith, T., Branham. (2008). Women with bipolar disorder who use alcohol
and other drugs. Journal of Addictions Nursing, 19(1), 55-60. doi:10.1080/1088
460082111739.
Stengler, M. (2004).The natural physician’s healing therapies: proven remedies that
medical doctors don’t know about. Stamford, CT. Prentice Hall.
Thomas, P. Challenging the globalization of biomedical psychiatry: Journal of Public
Mental Health: 4 (3) (2005) 23-32.