Treating the Cause of Tourette's and Related Tic Disorders

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About the Author

HUI ZHAO is the inspiration behind the founding of Lemon Fruit Health, based in Beijing, China. The service-oriented organization addresses neurodevelopmental disorders with a focus on natural treatment approaches. It provides vital information on treating tic disorders, including Tourette syndrome and associated disorders to include attention deficit hyperactivity disorder (ADHD) and anxiety, while encouraging new research in these areas.

Mr. Hui served as product director of a leading Chinese internet company and Chief Operating Officer at a listed, public Chinese video company. He also founded China’s premier pet brand for products and services. Mr. Hui transitioned from his corporate internet responsibilities to allow himself more time to focus on medical research after his child was diagnosed with a significant tic disorder and related neuropsychological conditions.

Through Mr. Hui’s investigative efforts, he successfully found answers to the cause of his son’s health problems. As his efforts progressed, the leading medical experts he consulted offered clues to the puzzle. He subsequently initiated a project that evolved into Lemon Fruit Health, aiming to share his medical insights with families and professionals in the field. For years, he has provided online assistance to parent groups, discussed his findings with professionals, and promoted publications from the Association for Comprehensive NeuroTherapy (Latitudes.org).

Mr. Hui’s inspiring personal account, highlighting his research and the recovery of his son’s medical condition, lays the groundwork for this document. A sampling of testimonials from families who have benefited from Mr. Hui’s outreach is included separately. Selected from many received, the stories offer a glimpse into the life-changing, positive impact Mr. Hui’s work has had on others who are searching for medical answers for their child. While the cause of tics can be numerous, focusing on finding the cause is the key to healing.

“Bodhisattvas fear the cause, while sentient beings fear the effect.”

This Buddhist saying conveys the concept that those who are
enlightened (Bodhisattvas) focus on the root cause of a situation,
while others are only concerned with the result.

Introduction

Knowledge is the greatest weapon to overcome the fear of neurodevelopmental disorders.

After much hesitation, I have decided to summarize my personal experiences and emotional journey over the past two years as I combated tics, hyperactivity, and anxiety in my young son. As you read this, please keep in mind that the article is extensive and includes not only medical and psychological research findings but also my personal understanding of these conditions. I will refer to my son as Sheng (to maintain his confidentiality).

I am grateful for the support my efforts received from parents, doctors, and teachers who assisted and encouraged me throughout this endeavor. Without experiencing the darkness of trying to help a sensitive child who was dealing with tics, ADHD, and anxiety, I might never have known that there are delicate angels in the world, such as Sheng, who require our utmost attention and care. In the process of dealing with these conditions, we may experience fear and feel helpless. We fear that the child may be “unable to recover fully.”

We worry about how our angels will face learning, how life in general will be impacted, and whether they will be able to have normal social interactions. We feel helpless because of “causes unknown.”

However, we must understand that “causes unknown” does not mean there are no trails to follow or new pathways to be forged. Our determination and our willingness to search for answers are our allies in the fight for our children’s health. Some of the many testimonials sent to me by families who searched for answers and ultimately succeeded in dealing with tic disorders using the approach described in this article are included at the end of this publication.

The early years

Sheng was born via cesarean section at 38 weeks due to insufficient amniotic fluid. Unfortunately, after birth, the mother’s milk supply was also insufficient, and we had to switch to mixed feeding after only three months. By five months, we completely relied on formula. We knew that breastmilk was preferable for his health, but we had no choice. I have often wondered if the formula we used may have played a role in his later development of tics and hyperactivity.

Overall, my son has been fairly easy to raise. However, his sleep was very poor before the age of three. He would cry and fuss at about midnight every night for nearly thirty minutes. I didn’t understand it at the time, but looking back, I suspect he was very uncomfortable, likely due to some sort of stomach discomfort. He was a picky eater until the age of six and tended to prefer meat more than vegetables. We were concerned that he often felt tired, and we were advised to have his cardiac enzymes tested. Abnormalities were found in his levels; after using coenzymes, his fatigue disappeared.

During the first few years, apart from having poor concentration, Sheng was generally healthy and did not have any major health issues. However, he developed pneumonia when he was four months old, and I personally believe it caused some lasting damage. He is slender but generally fit and has an extroverted personality.

Sheng enjoys socializing but tends to get impatient more easily than other children when interacting with friends. When younger, he was excitable and prone to anger. That has improved with the therapeutic approach we used, described below.

My son is highly intelligent, but concentrated study was not easy for him due to difficulties focusing. Yet, he is attentive to puzzles and activities, such as playing with Legos. We noticed his short attention span but didn’t think much about it until tics appeared.

First signs of symptoms

Our son showed signs of ADHD around the age of four, when his kindergarten teachers and chess instructors mentioned that he had a problem paying attention in their programs. It did not seem significant at the time. By the age of six, he began having symptoms of tics. These were mostly eye-blinking, nose-wrinkling, and mouth-twisting. At the time, we thought they were simply a bad habit. But in retrospect, it seemed there was an underlying physical issue causing his problems.

The first episode of tics lasted for a week without any intervention and resolved on its own.
The second episode involved eye-blinking and also lasted one week before resolving on its own.
The third episode occurred in October 2019 and started with nose-wrinkling and mouth-twisting, along with allergic rhinitis, adenoid hypertrophy (enlarged adenoids), snoring, and mouth-breathing. These symptoms were ongoing.

The following month, we took Sheng to the Capital Institute of Pediatrics, where he was prescribed the supplements acetyl-L-carnitine, B12, and JingLing Oral Solution, a Chinese combination medication. Together, the supplements are intended to have the effect of nourishing Yin and suppressing Yang, while calming the mind and improving focus. The doctor informed us that if there was no relief after a month of treatment, a diagnosis of combined tics and hyperactivity would be confirmed.

After we returned home from the appointment, my wife was extremely worried, though I didn’t take it too seriously. To ease her concerns, I consulted with the director of Peking University First Hospital. He advised us to ignore the symptoms. I assumed this meant everything would be fine and that it might just be a natural part of the child’s development process, which would improve over time. However, in the coming weeks, the situation seemed to take a turn for the worse.

While our son was taking the recommended acetyl-L-carnitine, B12, and JingLing Oral Solution, new tics developed. He began making strange neck-jerking movements, like slow-motion scenes from a movie. We continued to do our best to ignore these and not bring them to his attention.

In December 2019, before pandemic regulations resulted in restricted travel, we were overseas for the New Year’s celebrations when Sheng suddenly became emotionally irritable, had difficulty falling asleep, and started jerking his head backward, along with increased blinking and nose wrinkling. The entire family was shocked, and it was now impossible to ignore his condition.

Seeking medical help and treatment

After symptoms worsened, we quickly embarked on a journey of research and medical consultation. My father is a traditional Chinese medicine (TCM) practitioner, but I did not give our boy any TCM, mainly for two reasons:

First, TCM focuses on concepts like cold, phlegm, dampness, heat, and wind. While I could understand the concepts of cold, phlegm, dampness, and heat, I did not comprehend what “wind” is, such as liver wind, and how to eliminate it. What does it mean? That was never made clear to me. It should be noted that this is not to say TCM is ineffective, but rather that TCM requires high standards of study for doctors to properly treat and diagnose. Later, I used some small TCM prescriptions for him to help regulate the spleen and stomach, such as a ginseng, poria, atractylodes mix, kidney-tonifying tea, and bamboo leaf and honeysuckle, along with other classic Chinese herbs. My own health issues had successfully been addressed with TCM, and I was comfortable pursuing this approach.

Second, children have delicate organs, and I wanted to try treatments such as diet and psychology before resorting to standard medications.

Fortunately, due to my past work experience, I am comfortable working with numbers and data. I quickly did two things: I researched the incidence of neurodevelopmental disorders and studied the impact of diet on related disorders, particularly tics.

The incidence of neurodevelopmental disorders

I found that the incidence of neurodevelopmental disorders like tics and hyperactivity has increased in Beijing by seven to ten times during the past ten years. Some of this data mutation could be due to changes in diagnostic criteria or social awareness (with more attention given to mental health issues, more parents and educators may be more aware of children’s behavioral issues and seek professional help). Genetic mutations can also contribute to the increase, although they typically occur at a much slower pace.

The significant increase in incidence can also be attributed to the impact of environmental factors, including environmental pollution, changes in lifestyle, increased stress, and other factors that may affect the neurodevelopment of children, contributing to the documented rise in incidence. Recognizing that there must be deep underlying causes, I focused on identifying environmental factors that might have contributed to the dramatic increase in neurodevelopmental disorders, and I began by examining the diet.

Studying the diet connection

I created a simple list of what my child typically ate during the previous two months. Despite the abundance of food sources nowadays, the core staple foods are limited in variety.

I noticed that when symptoms worsened and he became more irritable, his milk intake had been three times higher than usual. Taking a chance for the sake of observation, I stopped giving him milk and milk products. A miraculous thing happened: one week after stopping milk, his head jerking disappeared, and his nose wrinkling significantly was reduced, though not completely. This marked the beginning of a new area of exploration into how diet affected his symptoms.

Learning from experts

At that time, due to the pandemic, we couldn’t visit a hospital for appointments, so I booked consultations with more than ten doctors listed on the “Good Doctor” online app. This app is often used as a reference to locate professionals and is not available in English.I selected several of them for long-term communication, including:

Director Lu Xiaoyan from the Department of Neurology at Beijing Children’s Hospital;
Director Huang Yanjun from the Children’s Hospital affiliated with Nanjing Medical University;
Director Yang Guang from the General Hospital of the PLA;
Director Zhou Zhongshu from the Department of Pediatrics at China-Japan Friendship Hospital;
Director Xu Pengfei from the Department of Pediatrics at China-Japan Friendship Hospital;
Director Sun Kexing from Shanghai Children’s Medical Center;
Director Zhang Yuanhua from Longhua Hospital in Shanghai;
Director Liu Chunyang from the Department of Pediatrics at Beijing Children’s Hospital;
Director Xiao Jianjun from Renji Hospital in Shanghai.
Pediatric Department of Beijing Children’s Hospital;

Frankly speaking, I have communicated with most of the renowned medical directors in China who specialize in treating tics and hyperactivity. At the time, I was in a state of desperation, seeing that our son seemed to have a number of physical and emotional concerns.

These doctors, including those specializing in neurology, pediatrics, digestive diseases, and pediatric health care, patiently provided me with explanations about tics and hyperactivity from different perspectives. This allowed me, a layman, to form my own judgment about the diseases.

For example, Director Zhang Yuanhua practices Traditional Chinese Medicine (TCM), but she does not emphasize wind elimination (a common concept in TCM) in her work. Her treatment focuses on regulating the body as a whole. Initially, I was skeptical about what she told me regarding the inducing and aggravating factors that could play a role in these conditions, such as frequent use of antibiotics, lack of sunlight exposure, and family atmosphere, including stress. At the time, I thought, “How could those have anything to do with triggering tics? And, regarding stress, in the era of intense competition in society, don’t all children face similar situations? Why don’t others tic?”

It wasn’t until I continued to research and found that a course of antibiotics could wipe out 90% of the intestinal microbiota, and that the microbiota is closely related to neurotransmitters, with 90% of serotonin and 50% of dopamine being produced in the intestine, that I began to understand. Additionally, approximately 90% of vitamin D is produced under the skin through exposure to ultraviolet light. All these factors can be closely related to the development of tics. It turned out that Director Zhang’s seemingly casual remarks on this topic were correct.

Another example of important information I learned came from Director Xiao Jianjun, who informed me that most children with neurodevelopmental disorders have imbalanced intestinal microbiota or other gastrointestinal tract issues.

Director Liu Chunyang informed me that if using conventional medications for tics and ADHD, it is important to consider the child’s growth and development before prescribing. This alerted me to concerns about the potential negative side effects of these drugs.

Director Xu Pengfei discussed the potential mutation points in allergy and food intolerance, intestinal microbiota, and folate metabolism. Folate metabolic disorders may indirectly increase the risk of allergies by affecting the normal function of the immune system.

After gathering all this information, I decisively abandoned the recommendations I had received from an outpatient department for neurodevelopmental disorders—the Neurology Department—because I felt that using drugs like clonidine (a hypertensive), or sulpiride and risperidone (antipsychotics), on children is a double-edged sword. The medication might control some of the tic symptoms, but it could also make the child drowsy, overweight, and irritable, among other undesirable side effects. I didn’t want to have a child who no longer had tics but who had been made drowsy, depressed, overweight, and/or irritable. This seemed counterproductive for what we were trying to accomplish for our child.

I still felt I could find a safer path, and thus I joined various parent support groups. I am especially grateful for the help from these group moderators, who clarified key concepts for me. For example:

The role of specific nutrients in body repair was introduced to me, and the importance of food intolerance was emphasized. This awareness led to the elimination of my son’s milk consumption, which resulted in the disappearance of head-jerking. Food intolerances were clearly part of his physical response condition.

The path of evidence-based practice

The above parental perspectives, combined with my communication with doctors, suddenly seemed to open a new horizon. I learned that there were foreign trials on vitamin B6 and magnesium for tic treatment, foreign trials on gluten-free diet treatment, domestic trials on vitamin D3 treatment, and clinical experiments on probiotic interventions for tics. After further research, I saw that B vitamins are water-soluble and safe at reasonable doses, vitamin D is fat-soluble and safe at reasonable doses, and probiotics are also safe and important. I embarked on the path of evidence-based practice.

Checking for allergies and food intolerances

We pursued allergy testing for our son. Unfortunately, although the total IgE levels for allergies were quite high (indicating a higher-than-average allergic response), no specific allergens were detected out of the fourteen tested, and food intolerance was undetected. Yet, we had already clearly discovered that consuming milk was not suitable for our boy. I realized this testing would not provide us with all the answers we were going to need related to other possible food sensitivities.

Out of necessity, we carefully began the process of dietary elimination without telling my son what we were doing. We eliminated all of these items and anything containing them:

Milk
Eggs
Wheat
Processed snacks
Monosodium glutamate (MSG)
High-sugar foods
Certain fruits
Nuts
Seafood

Many of these are common allergens, while others are foods that may not be well tolerated by certain individuals. After one to two months of this strict dietary restriction, the child’s facial movements had ceased, including the head-jerking that had previously stopped when milk was eliminated.

Assessing intestinal permeability and intestinal microbiota

Based on a stool sample test, the score for intestinal microbiota was a mere 2 points, which was shockingly low. The gut microbiome score is a quantitative assessment of the diversity and balance of the gut microbiota. In this case, the level of Bifidobacterium genus was at a barely acceptable level, while Lactobacillus was not detected at all. A deficiency in the number of beneficial bacteria can impact numerous physiological functions, including digestion, absorption, immune regulation, and vitamin synthesis. They help maintain the integrity of the gut barrier, inhibit the growth of harmful bacteria, and participate in the metabolic processes of various nutrients. I knew this was an area that would need attention.

Other evaluations

Checking for heavy metals: Heavy metals were tested through blood and hair samples. No heavy metals were found to exceed normal limits.

Investigating folate metabolism: Testing confirmed a mutation at the folate metabolism site.

Anti-‘O’ antibodies: The Anti-‘O’ antibody (Antistreptolysin O Titer) level was 240, which was double the normal value. This indicates a prior or present strep infection. Realizing that long-term penicillin was often recommended to lower these antibody levels, and recalling the potential harm of antibiotics, we decided against treating this at the time. Antibodies often decrease over time, and we chose to be vigilant and observe him for the possibility of a streptococcal infection. We were aware of the necessity of careful monitoring.

Looking back

I have spent a great deal of time revisiting my wife’s pregnancy and the delivery. I previously mentioned the cesarean section delivery. The cesarean process, which takes place in a sterile environment, can be detrimental to the establishment of a child’s intestinal microbiome later on, depriving the infant of the first microbial exchange with the mother. Often, neurological issues coexist with gastrointestinal problems, with the intestine influencing the brain. Given this, children born via cesarean section may be more prone to tics and hyperactivity than those who have a vaginal birth; this warrants future study and is the focus of the scholarly research noted at the end of this article.

During pregnancy, my wife did not use progesterone or levothyroxine (thyroid medication). She also did not suffer from postpartum depression, which is sometimes treated with allopregnanolone. However, information on these medications is included here in case it is helpful to readers. This medication, a neurosteroid and antidepressant, was linked to offspring exhibiting tic-like symptoms in a study at the University of Utah when pregnant mice were injected with the drug. Although not an issue in our case, it is something to consider when investigating the initial causes of tics.

While it’s impossible to determine whether a specific child’s tics and hyperactivity are directly related to what I mentioned above, potential perinatal injuries and changes in gene expression do exist.

The path of regulation: What we did

Despite the IgE and IgG testing not yielding helpful results regarding diet, we utilized temporary eliminations (foods previously noted above) for one to two months, slowly reintroducing them one at a time to observe any reactions. After the dietary restrictions, my son’s mood swings and facial movements disappeared. Then we gradually reintroduced fruits: avocado first, observe; then blueberries, observe; cranberries, observe, and so on.

Apart from milk products and egg whites, Sheng was able to return to eating the other foods again.

Rotation of foods: We reintroduced foods one at a time. If symptoms reappeared, we would do a review and wait a few weeks before reintroducing that food.

Substitutions: We replaced refined seed oils, such as peanut and corn oil, as they reportedly can cause an imbalance between omega-6 and omega-3 levels, which compete for a particularly important enzyme, with omega-6 usually winning. We switched to high-quality olive oil, grape seed oil, and Xanthoceras tree oil, which is rich in neuraminic acid. During the dietary restriction period, we replaced the soy sauce we had been using with gluten-free or traditional soy sauce (that contains no wheat).

Nutrients First and foremost, we must abandon the idea that nutrients work the same way medicines do, because they do not. Faced with neurodevelopmental disorders, if you want a quick recovery or reaction, you can either choose to try medications, whether it’s TCM or Western medicine. Or, you can opt for a slower approach of dietary restrictions along with specific nutrients. Between the two, we chose the latter.

Some of the core nutrients for addressing tics and ADHD, as I understand it, are as follows. (Keep in mind that individual needs vary and care should be taken to provide the proper balance.)

Vitamin B complex: Eliminates intestinal inflammation, coenzymes for neurotransmitter synthesis, and vitamin B complex is water-soluble, meaning the body metabolizes and excretes it if not absorbed.

Vitamin D: Repairs the immune barrier, prevents allergies, promotes the absorption of minerals like calcium, etc.

Magnesium: Stabilizes nerves, promotes calcium absorption, aids sleep, and regulates serum vitamin D concentration.

Zinc: In the eyes of some scholars, it is also a neurotransmitter, regulating the levels of glutamate and gamma-aminobutyric acid in the brain. However, when supplementing with zinc, it is important to note the zinc-copper antagonism. (Levels of one mineral decrease as the other increases, and vice versa)

Vitamin C: Clears free radicals and fights chronic inflammation

My understanding of neurodevelopmental disorders

Neurodevelopmental disorders, such as tics and hyperactivity, are widely recognized abroad as being closely related to the immune system. Allergies and food intolerances are also closely linked to the immune system. This does not mean that the child’s immunity is weak; rather, it indicates that the immune response is overactive.

Neurodevelopmental disorders, to some extent, resemble an advanced allergic reaction, with the allergy manifesting in the brain and nervous system. We need to break the perception here: allergic reactions do not necessarily manifest on the skin. 12% of people may experience symptoms in the nervous system. Parents with allergies can try to recall whether they experience “brain fog” when they have a severe reaction, meaning their brain feels fuzzy, dizzy, or disoriented. This is not due to oxygen deficiency but an allergic reaction, which may also manifest as irritability.
Neurodevelopmental disorders and brain diseases, as well as many neurological disorders, are often invisible and intangible. They cannot be reliably and directly medicated by a doctor who relies only on experience and conjecture for a diagnosis. Unfortunately, there is no unified diagnostic standard or method for determining the cause of conditions such as Tourette syndrome or ADHD. Families are typically told that the cause is unknown, and there is no cure. However, because of the gut-brain axis (the brain and gut regulating each other through the vagus nerve), adjusting the health of the gut to positively affect the brain is a good approach.
The intestine is the largest immune organ in the human body, and it is an external environment for the brain. The intestine can also be hypersensitive or experience allergic reactions.
The immune system can invade the nervous system and affect the mental system, so the priority is to balance the immune system.
Reasonable nutrients are needed to speed up the body’s recovery. Taking the intestine as an example, the intestinal wall completely metabolizes into new tissue every two weeks. However, during this process, repairing and reducing intestinal pressure are the core. A better, but more laborious method, is to obtain nutrients from food. However, during the body’s repair stage, supplementing with nutrients is necessary, and the dosage should be relatively larger than can be obtained from food.
In summary, the treatment of neurodevelopmental disorders requires a focus on key factors affecting the disorder, particularly the immune system, metabolism, and neurotransmitter imbalances. The core of the immune system is the intestine, and chronic inflammation of the intestine plays a key role in the immune system, as well as neurotransmitter imbalance. The purpose of dietary restrictions is to reduce chronic inflammation and intestinal pressure, while the purpose of select nutrient supplements is to further reduce chronic inflammation and promote intestinal repair.

Finally, I share my adapted version of the well-known Serenity Prayer:

I hope you can be calm and accept what cannot be changed.

I hope you have the courage to change what can be changed;

I hope you have the wisdom to distinguish between the two.

Overcoming tics, hyperactivity, and anxiety may take three months, six months, or a year. During this process, setbacks may occur, but we believe that as long as we remain on the right path, the day of healing will eventually come.

References in text:

“The impact of Caesarean section on the microbiome” Delphine M Hoang, Elvira Levy, Yvan Vanderplas. https://pubmed.ncbi.nlm.nih.gov/33405258/

Allopregnanolone mediates the exacerbation of Tourette-like responses by acute stress in mouse models. Laura J Mosher, Sean C Godar, Marianela Nelson, et al. https://pubmed.ncbi.nlm.nih.gov/28611376/