I first met Josh, with his parents, when he was 15 years old. His parents began that first visit with a diatribe of complaints about Josh, from his preschool years to his present state. They listed symptoms including inattention, oppositional behaviors, depression, suicidal ideation, academic failure, obesity, and recent experimentation with alcohol and drugs. They carefully categorized years of medical and psychological interventions including evaluations by university clinics and a recent residential treatment program for children.

Josh’s parents repeatedly stated that they were “at their wits end.” The most concerning statement they made during this first visit was in response to my routine question: “Can you tell me about Josh’s strengths?” They both looked at me, and his mother began to cry while his father stated, “I can’t think of any strengths.” Josh sat passively by listening to this description, offering rare monosyllabic responses to questions.

I began meeting with Josh and his family weekly, and began my search for what was missing. His response to medications was atypical and side effects were more noticeable than positive effects. Yet, when he was off medications he had increased symptoms of depression, including suicidal ideation. After 7 months of evaluation, counseling and consultation I decided to investigate nutritional experts. My original thought was that Josh’s obesity was interfering with the absorption and metabolism of his medications. I then began reviewing recent research on micronutrients and discovered Josh had never been evaluated for malabsorption syndromes.

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I met with his family again and through a more in depth history discovered that Josh and his older brother had a history of chronic diarrhea as young toddlers, with weight loss. His older brother was diagnosed with failure to thrive, and his mother struggled to keep weight on him throughout his school age years. During adolescence, the diarrhea stopped. At age 21 years Josh’s brother was diagnosed with Bipolar I disorder.

Josh’s diarrhea was not as severe, and his mother forgot that it had been a problem. She also noted that two other relatives had been diagnosed with Celiac disease. Josh’s diet was rich in carbohydrates; he was consuming six-to-eight servings of wheat products per day. We tested him for wheat intolerance, and he tested positive. Josh was amazingly willing to change to a gluten-free diet and stopped eating gluten overnight.

The change was dramatic. Within three months Josh transformed from a dull angry adolescent who was failing classes in an individual education plan to a bright young man achieving As and Bs. He began to lose weight and, over the next year, dropped from 250 pounds to 180 pounds. He began exercising and his desire for positive social interaction increased. His eye contact and interactive skills improved. His depression lifted, and his moods stabilized. Today, three years later, he continues to thrive and will complete high school with honors. His parents now have a long list of strengths.

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