adhd march 2015
TRANSCRIPT
Managing ADHDWith Dietary amp Nutritional Support
Limited seating availableRegister now
wwworthomolecularhealthcom or 4167332117
OrthoHealthOrthomolecular Health
An estimated 5 of Canadian children struggle with ADHD Cognitive learning social amp emotional challenges often overlap Research is increasingly linking ADHD amp LDs with diet nutrition amp neurodevelopment In this discussion you will learn
Chemical SensitivitiesToxicity Vitamin amp Mineral Deficencies Dysbiosis
Orthomolecular Medicine for ADHD
Wednesday March 25th 7 - 9 PM
Dr Zoltan Rona is a graduate of McGill University Medical School amp has a Masterrsquos Degree in Biochemistry amp Clinical Nutrition from the University of Bridgeport in Con-necticut He is the author of several books has appeared on radio amp TV as well as lectured extensively in Canada amp the US
Public Seminar
GALBRAITH BUILDING - Room 24435 St George Street University of Toronto
Advance Registration $10 | Door $15Pay what you can available by request
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Autism ADD Learning Disorders
KIDS ON DRUGS ndash Therersquos a Better
Approach to ADHDby Dr Zoltan P Rona MD MSc
On the way to work one day recently I saw a bright sandwich billboard that read ldquoDo You Suffer
From ADHD Naturopathic Medicine Can Helprdquo The phone number listed was that of a local
naturopathic clinic
As our children go back to school there are a growing number of reports that the use of
amphetamine drug prescriptions (Ritalin Methylphena-date Adderall Concerta Vyvance and
others) has escalated to an alarming degree
On May 16 2014 the New York Times reported on a study
which found that over 10000 toddlers between the ages of
two and three were being prescribed these dangerous
stimulants for treatment of attention deficit hyperactivity
disorder (ADHD) As pointed out in the article this
prescribing pattern is outside established pediatric guidelines
Nevertheless it is happening and there are no medical
licensing bodies in North America doing anything about it If
anything itrsquos encouraged
ldquoThe way to sell drugs is to sell psychiatric illnessrdquo ~ Dr Carl
Elliot University of Minnesota Bioethicist (The Washington
Post 2001)
Chief amongst the side effects of these amphetamines are
growth retardation and cardiovascular disease In fact the
Toronto Star reported in 2012 that Canadian child deaths due
to cardiovascular disease resulting from these drugs was on
the rise Childhood strokes convulsions tics hallucinations
psychotic breaks schizoid reactions mania depression and
suicide have all been reported as a consequence of ADHD
March 2015
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LEAKY GUT SYNDROME A BOWELDISORDER PLAYS AN IMPORTANT ROLE INADHD AND OTHER BRAIN DISORDERS Slideshow 1 2Slideshow 1 2 1 2
httpvitalitymagazinecomarticlekids-on-drugs
ADHD Symptoms
bull Inattention1 Easily distracted
2 Forgetful
3 Loses things
4 Difficulty sustaining attention
5 Avoiddislike difficult tasks
6 Difficulty organizing
7 Careless mistakes
8 Doesnrsquot listen
9 Difficulty following instructions
bull HyperactiveImpulsive1 Fidgety2 Difficulty staying in seat3 Runs or climbs
excessively Hyper feeling
4 Acts on the go driven by a motor
5 Difficulty doing things quietly
6 Talks excessively7 Difficulty waiting turn8 Blurts out answers9 Interruptsintrudes
Differential Diagnosis
bull Vision and hearing problems
bull Chronic illness with itch breathing impairment eg sleep apnea sleep problems
bull Developmental or learning problems language deficits
bull Absence seizures
bull Acute change in living situation grief family conflict recent trauma
bull Substance abuse side effect of medications
bull Stress
bull FREQUENT CO-MORBIDITIES (Other mood or anxiety disorder psychotic disorder adjustment disorder) fixing them can solve most of the problem (next slide)
ADHD Comorbidity
bull Learning Disability 37-50
bull Anxiety 20 to 33
bull Depression 10 to 20
bull Bipolar 63 to 92 of Pediatric BPD also meets criteria for ADHD
bull OCD 40
bull Conduct Disorder 20
bull TourettesTics7
CDC Data amp Statistics
bull CDCs Summary Health Statistics for US Children National Health Interview Survey 2009 (December 2010 Series 10 Number 247)
bull 21 million children between the ages of 5 to 11 have ADHD (76)
bull 3 million children between the ages of 12 to 17 have ADHD (122)
Epidemiology
bull Prevalence 4-11 in US
bull Boys Girls 31
bull Etiology multifactorial ndash Genetic ndash family history of ADHD
alcoholism sociopathy LD mood and anxiety disorders
ndash Medical (maternal smoking and alcohol use during pregnancy gestational diabetes head injury seizures CNS infection OSAS) and
ndash Environmental risks (lead CO Cd TV) and protective factors (high IQ supportive structured family environment)
ndash Cultural ndash much lower prevalence estimates in Europe and Japan than US
ndash many unknowns
TV and Attention
bull TV viewing accounted for
significant portion of the
variation in ratings of ADHD ss
(Miller CJ 2007)
bull Frequent television viewing
associated with subsequent
attention and school problems
(Johnson JG 2007)
bull No evidence of bidirectionality
between TV time and
AttentionLearning issues
(Johnson JG 2007)
Whatrsquos wrong
with his brain
bull 446 kids with and without ADHD scanned
repeatedly over years
bull ADHD kids lag 3 yrs in cortical growth
bull ADHD motor cortex matures earlier
bull Brain imaging not clinical tool
bull No evidence of abnormality only delay
Shaw P National Academy of Science 2007
bull One physician Dr Michael Anderson of Canton Georgia calls ADHD a ldquomade uprdquo disorder ldquoan excuserdquo for doctors to prescribe Adderall to treat poor academic performance in inadequate schools
bull October 16 2012
CDC Data amp Statistics
CDC Data amp Statistics
bull The prevalence of children 4-17 years of age taking ADHD medication increased from 48 in 2007 to 61 in 2011
CDC REPORTS ECONOMIC COST
bull Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is estimated to be between $12005 and $17458 annually per individual
bull Across 10 countries it was projected that ADHD was associated with 1438 million lost days of productivity each year Most of this loss can be attributed to ADHD and not co-occurring conditions
Ritalin Use in the United StatesEstimated Number of Children Taking
RitalinPrescriptions of Ritalin for attention deficit hyperactivity
disorder have quadrupled in a decade
1970 - 150000
1980 - Between 270000 and 541000
1990 - 900000
2003 - 25 million
2012 ndash 6 million
Medication Challenges
bull Poor responsendash Poor response in 35 (no behavioral improvement)
ndash Side effects gt50 nausea weight loss insomnia tics irritability not himself arryhthmias liver dysfunction
ndash Increase in calls to Poison Control Centers
ndash Failure to take them stigma dependence
ndash Lack of attention to other aspects of lifestyle that improve overall health and esteem
bull Parents seek other options (30 - 40)
Chan E J Dev Beh Ped 2003Psychopharm Bull 2008 4137-47
Setlick J Pediatrics 2009 124 875-80
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
The Trusted Source for Natural Health Solutions Search this website
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Autism ADD Learning Disorders
KIDS ON DRUGS ndash Therersquos a Better
Approach to ADHDby Dr Zoltan P Rona MD MSc
On the way to work one day recently I saw a bright sandwich billboard that read ldquoDo You Suffer
From ADHD Naturopathic Medicine Can Helprdquo The phone number listed was that of a local
naturopathic clinic
As our children go back to school there are a growing number of reports that the use of
amphetamine drug prescriptions (Ritalin Methylphena-date Adderall Concerta Vyvance and
others) has escalated to an alarming degree
On May 16 2014 the New York Times reported on a study
which found that over 10000 toddlers between the ages of
two and three were being prescribed these dangerous
stimulants for treatment of attention deficit hyperactivity
disorder (ADHD) As pointed out in the article this
prescribing pattern is outside established pediatric guidelines
Nevertheless it is happening and there are no medical
licensing bodies in North America doing anything about it If
anything itrsquos encouraged
ldquoThe way to sell drugs is to sell psychiatric illnessrdquo ~ Dr Carl
Elliot University of Minnesota Bioethicist (The Washington
Post 2001)
Chief amongst the side effects of these amphetamines are
growth retardation and cardiovascular disease In fact the
Toronto Star reported in 2012 that Canadian child deaths due
to cardiovascular disease resulting from these drugs was on
the rise Childhood strokes convulsions tics hallucinations
psychotic breaks schizoid reactions mania depression and
suicide have all been reported as a consequence of ADHD
March 2015
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Annual Getaway Guide 2014
Annual Guide to Organics2014
LEAKY GUT SYNDROME A BOWELDISORDER PLAYS AN IMPORTANT ROLE INADHD AND OTHER BRAIN DISORDERS Slideshow 1 2Slideshow 1 2 1 2
httpvitalitymagazinecomarticlekids-on-drugs
ADHD Symptoms
bull Inattention1 Easily distracted
2 Forgetful
3 Loses things
4 Difficulty sustaining attention
5 Avoiddislike difficult tasks
6 Difficulty organizing
7 Careless mistakes
8 Doesnrsquot listen
9 Difficulty following instructions
bull HyperactiveImpulsive1 Fidgety2 Difficulty staying in seat3 Runs or climbs
excessively Hyper feeling
4 Acts on the go driven by a motor
5 Difficulty doing things quietly
6 Talks excessively7 Difficulty waiting turn8 Blurts out answers9 Interruptsintrudes
Differential Diagnosis
bull Vision and hearing problems
bull Chronic illness with itch breathing impairment eg sleep apnea sleep problems
bull Developmental or learning problems language deficits
bull Absence seizures
bull Acute change in living situation grief family conflict recent trauma
bull Substance abuse side effect of medications
bull Stress
bull FREQUENT CO-MORBIDITIES (Other mood or anxiety disorder psychotic disorder adjustment disorder) fixing them can solve most of the problem (next slide)
ADHD Comorbidity
bull Learning Disability 37-50
bull Anxiety 20 to 33
bull Depression 10 to 20
bull Bipolar 63 to 92 of Pediatric BPD also meets criteria for ADHD
bull OCD 40
bull Conduct Disorder 20
bull TourettesTics7
CDC Data amp Statistics
bull CDCs Summary Health Statistics for US Children National Health Interview Survey 2009 (December 2010 Series 10 Number 247)
bull 21 million children between the ages of 5 to 11 have ADHD (76)
bull 3 million children between the ages of 12 to 17 have ADHD (122)
Epidemiology
bull Prevalence 4-11 in US
bull Boys Girls 31
bull Etiology multifactorial ndash Genetic ndash family history of ADHD
alcoholism sociopathy LD mood and anxiety disorders
ndash Medical (maternal smoking and alcohol use during pregnancy gestational diabetes head injury seizures CNS infection OSAS) and
ndash Environmental risks (lead CO Cd TV) and protective factors (high IQ supportive structured family environment)
ndash Cultural ndash much lower prevalence estimates in Europe and Japan than US
ndash many unknowns
TV and Attention
bull TV viewing accounted for
significant portion of the
variation in ratings of ADHD ss
(Miller CJ 2007)
bull Frequent television viewing
associated with subsequent
attention and school problems
(Johnson JG 2007)
bull No evidence of bidirectionality
between TV time and
AttentionLearning issues
(Johnson JG 2007)
Whatrsquos wrong
with his brain
bull 446 kids with and without ADHD scanned
repeatedly over years
bull ADHD kids lag 3 yrs in cortical growth
bull ADHD motor cortex matures earlier
bull Brain imaging not clinical tool
bull No evidence of abnormality only delay
Shaw P National Academy of Science 2007
bull One physician Dr Michael Anderson of Canton Georgia calls ADHD a ldquomade uprdquo disorder ldquoan excuserdquo for doctors to prescribe Adderall to treat poor academic performance in inadequate schools
bull October 16 2012
CDC Data amp Statistics
CDC Data amp Statistics
bull The prevalence of children 4-17 years of age taking ADHD medication increased from 48 in 2007 to 61 in 2011
CDC REPORTS ECONOMIC COST
bull Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is estimated to be between $12005 and $17458 annually per individual
bull Across 10 countries it was projected that ADHD was associated with 1438 million lost days of productivity each year Most of this loss can be attributed to ADHD and not co-occurring conditions
Ritalin Use in the United StatesEstimated Number of Children Taking
RitalinPrescriptions of Ritalin for attention deficit hyperactivity
disorder have quadrupled in a decade
1970 - 150000
1980 - Between 270000 and 541000
1990 - 900000
2003 - 25 million
2012 ndash 6 million
Medication Challenges
bull Poor responsendash Poor response in 35 (no behavioral improvement)
ndash Side effects gt50 nausea weight loss insomnia tics irritability not himself arryhthmias liver dysfunction
ndash Increase in calls to Poison Control Centers
ndash Failure to take them stigma dependence
ndash Lack of attention to other aspects of lifestyle that improve overall health and esteem
bull Parents seek other options (30 - 40)
Chan E J Dev Beh Ped 2003Psychopharm Bull 2008 4137-47
Setlick J Pediatrics 2009 124 875-80
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
ADHD Symptoms
bull Inattention1 Easily distracted
2 Forgetful
3 Loses things
4 Difficulty sustaining attention
5 Avoiddislike difficult tasks
6 Difficulty organizing
7 Careless mistakes
8 Doesnrsquot listen
9 Difficulty following instructions
bull HyperactiveImpulsive1 Fidgety2 Difficulty staying in seat3 Runs or climbs
excessively Hyper feeling
4 Acts on the go driven by a motor
5 Difficulty doing things quietly
6 Talks excessively7 Difficulty waiting turn8 Blurts out answers9 Interruptsintrudes
Differential Diagnosis
bull Vision and hearing problems
bull Chronic illness with itch breathing impairment eg sleep apnea sleep problems
bull Developmental or learning problems language deficits
bull Absence seizures
bull Acute change in living situation grief family conflict recent trauma
bull Substance abuse side effect of medications
bull Stress
bull FREQUENT CO-MORBIDITIES (Other mood or anxiety disorder psychotic disorder adjustment disorder) fixing them can solve most of the problem (next slide)
ADHD Comorbidity
bull Learning Disability 37-50
bull Anxiety 20 to 33
bull Depression 10 to 20
bull Bipolar 63 to 92 of Pediatric BPD also meets criteria for ADHD
bull OCD 40
bull Conduct Disorder 20
bull TourettesTics7
CDC Data amp Statistics
bull CDCs Summary Health Statistics for US Children National Health Interview Survey 2009 (December 2010 Series 10 Number 247)
bull 21 million children between the ages of 5 to 11 have ADHD (76)
bull 3 million children between the ages of 12 to 17 have ADHD (122)
Epidemiology
bull Prevalence 4-11 in US
bull Boys Girls 31
bull Etiology multifactorial ndash Genetic ndash family history of ADHD
alcoholism sociopathy LD mood and anxiety disorders
ndash Medical (maternal smoking and alcohol use during pregnancy gestational diabetes head injury seizures CNS infection OSAS) and
ndash Environmental risks (lead CO Cd TV) and protective factors (high IQ supportive structured family environment)
ndash Cultural ndash much lower prevalence estimates in Europe and Japan than US
ndash many unknowns
TV and Attention
bull TV viewing accounted for
significant portion of the
variation in ratings of ADHD ss
(Miller CJ 2007)
bull Frequent television viewing
associated with subsequent
attention and school problems
(Johnson JG 2007)
bull No evidence of bidirectionality
between TV time and
AttentionLearning issues
(Johnson JG 2007)
Whatrsquos wrong
with his brain
bull 446 kids with and without ADHD scanned
repeatedly over years
bull ADHD kids lag 3 yrs in cortical growth
bull ADHD motor cortex matures earlier
bull Brain imaging not clinical tool
bull No evidence of abnormality only delay
Shaw P National Academy of Science 2007
bull One physician Dr Michael Anderson of Canton Georgia calls ADHD a ldquomade uprdquo disorder ldquoan excuserdquo for doctors to prescribe Adderall to treat poor academic performance in inadequate schools
bull October 16 2012
CDC Data amp Statistics
CDC Data amp Statistics
bull The prevalence of children 4-17 years of age taking ADHD medication increased from 48 in 2007 to 61 in 2011
CDC REPORTS ECONOMIC COST
bull Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is estimated to be between $12005 and $17458 annually per individual
bull Across 10 countries it was projected that ADHD was associated with 1438 million lost days of productivity each year Most of this loss can be attributed to ADHD and not co-occurring conditions
Ritalin Use in the United StatesEstimated Number of Children Taking
RitalinPrescriptions of Ritalin for attention deficit hyperactivity
disorder have quadrupled in a decade
1970 - 150000
1980 - Between 270000 and 541000
1990 - 900000
2003 - 25 million
2012 ndash 6 million
Medication Challenges
bull Poor responsendash Poor response in 35 (no behavioral improvement)
ndash Side effects gt50 nausea weight loss insomnia tics irritability not himself arryhthmias liver dysfunction
ndash Increase in calls to Poison Control Centers
ndash Failure to take them stigma dependence
ndash Lack of attention to other aspects of lifestyle that improve overall health and esteem
bull Parents seek other options (30 - 40)
Chan E J Dev Beh Ped 2003Psychopharm Bull 2008 4137-47
Setlick J Pediatrics 2009 124 875-80
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Differential Diagnosis
bull Vision and hearing problems
bull Chronic illness with itch breathing impairment eg sleep apnea sleep problems
bull Developmental or learning problems language deficits
bull Absence seizures
bull Acute change in living situation grief family conflict recent trauma
bull Substance abuse side effect of medications
bull Stress
bull FREQUENT CO-MORBIDITIES (Other mood or anxiety disorder psychotic disorder adjustment disorder) fixing them can solve most of the problem (next slide)
ADHD Comorbidity
bull Learning Disability 37-50
bull Anxiety 20 to 33
bull Depression 10 to 20
bull Bipolar 63 to 92 of Pediatric BPD also meets criteria for ADHD
bull OCD 40
bull Conduct Disorder 20
bull TourettesTics7
CDC Data amp Statistics
bull CDCs Summary Health Statistics for US Children National Health Interview Survey 2009 (December 2010 Series 10 Number 247)
bull 21 million children between the ages of 5 to 11 have ADHD (76)
bull 3 million children between the ages of 12 to 17 have ADHD (122)
Epidemiology
bull Prevalence 4-11 in US
bull Boys Girls 31
bull Etiology multifactorial ndash Genetic ndash family history of ADHD
alcoholism sociopathy LD mood and anxiety disorders
ndash Medical (maternal smoking and alcohol use during pregnancy gestational diabetes head injury seizures CNS infection OSAS) and
ndash Environmental risks (lead CO Cd TV) and protective factors (high IQ supportive structured family environment)
ndash Cultural ndash much lower prevalence estimates in Europe and Japan than US
ndash many unknowns
TV and Attention
bull TV viewing accounted for
significant portion of the
variation in ratings of ADHD ss
(Miller CJ 2007)
bull Frequent television viewing
associated with subsequent
attention and school problems
(Johnson JG 2007)
bull No evidence of bidirectionality
between TV time and
AttentionLearning issues
(Johnson JG 2007)
Whatrsquos wrong
with his brain
bull 446 kids with and without ADHD scanned
repeatedly over years
bull ADHD kids lag 3 yrs in cortical growth
bull ADHD motor cortex matures earlier
bull Brain imaging not clinical tool
bull No evidence of abnormality only delay
Shaw P National Academy of Science 2007
bull One physician Dr Michael Anderson of Canton Georgia calls ADHD a ldquomade uprdquo disorder ldquoan excuserdquo for doctors to prescribe Adderall to treat poor academic performance in inadequate schools
bull October 16 2012
CDC Data amp Statistics
CDC Data amp Statistics
bull The prevalence of children 4-17 years of age taking ADHD medication increased from 48 in 2007 to 61 in 2011
CDC REPORTS ECONOMIC COST
bull Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is estimated to be between $12005 and $17458 annually per individual
bull Across 10 countries it was projected that ADHD was associated with 1438 million lost days of productivity each year Most of this loss can be attributed to ADHD and not co-occurring conditions
Ritalin Use in the United StatesEstimated Number of Children Taking
RitalinPrescriptions of Ritalin for attention deficit hyperactivity
disorder have quadrupled in a decade
1970 - 150000
1980 - Between 270000 and 541000
1990 - 900000
2003 - 25 million
2012 ndash 6 million
Medication Challenges
bull Poor responsendash Poor response in 35 (no behavioral improvement)
ndash Side effects gt50 nausea weight loss insomnia tics irritability not himself arryhthmias liver dysfunction
ndash Increase in calls to Poison Control Centers
ndash Failure to take them stigma dependence
ndash Lack of attention to other aspects of lifestyle that improve overall health and esteem
bull Parents seek other options (30 - 40)
Chan E J Dev Beh Ped 2003Psychopharm Bull 2008 4137-47
Setlick J Pediatrics 2009 124 875-80
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
ADHD Comorbidity
bull Learning Disability 37-50
bull Anxiety 20 to 33
bull Depression 10 to 20
bull Bipolar 63 to 92 of Pediatric BPD also meets criteria for ADHD
bull OCD 40
bull Conduct Disorder 20
bull TourettesTics7
CDC Data amp Statistics
bull CDCs Summary Health Statistics for US Children National Health Interview Survey 2009 (December 2010 Series 10 Number 247)
bull 21 million children between the ages of 5 to 11 have ADHD (76)
bull 3 million children between the ages of 12 to 17 have ADHD (122)
Epidemiology
bull Prevalence 4-11 in US
bull Boys Girls 31
bull Etiology multifactorial ndash Genetic ndash family history of ADHD
alcoholism sociopathy LD mood and anxiety disorders
ndash Medical (maternal smoking and alcohol use during pregnancy gestational diabetes head injury seizures CNS infection OSAS) and
ndash Environmental risks (lead CO Cd TV) and protective factors (high IQ supportive structured family environment)
ndash Cultural ndash much lower prevalence estimates in Europe and Japan than US
ndash many unknowns
TV and Attention
bull TV viewing accounted for
significant portion of the
variation in ratings of ADHD ss
(Miller CJ 2007)
bull Frequent television viewing
associated with subsequent
attention and school problems
(Johnson JG 2007)
bull No evidence of bidirectionality
between TV time and
AttentionLearning issues
(Johnson JG 2007)
Whatrsquos wrong
with his brain
bull 446 kids with and without ADHD scanned
repeatedly over years
bull ADHD kids lag 3 yrs in cortical growth
bull ADHD motor cortex matures earlier
bull Brain imaging not clinical tool
bull No evidence of abnormality only delay
Shaw P National Academy of Science 2007
bull One physician Dr Michael Anderson of Canton Georgia calls ADHD a ldquomade uprdquo disorder ldquoan excuserdquo for doctors to prescribe Adderall to treat poor academic performance in inadequate schools
bull October 16 2012
CDC Data amp Statistics
CDC Data amp Statistics
bull The prevalence of children 4-17 years of age taking ADHD medication increased from 48 in 2007 to 61 in 2011
CDC REPORTS ECONOMIC COST
bull Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is estimated to be between $12005 and $17458 annually per individual
bull Across 10 countries it was projected that ADHD was associated with 1438 million lost days of productivity each year Most of this loss can be attributed to ADHD and not co-occurring conditions
Ritalin Use in the United StatesEstimated Number of Children Taking
RitalinPrescriptions of Ritalin for attention deficit hyperactivity
disorder have quadrupled in a decade
1970 - 150000
1980 - Between 270000 and 541000
1990 - 900000
2003 - 25 million
2012 ndash 6 million
Medication Challenges
bull Poor responsendash Poor response in 35 (no behavioral improvement)
ndash Side effects gt50 nausea weight loss insomnia tics irritability not himself arryhthmias liver dysfunction
ndash Increase in calls to Poison Control Centers
ndash Failure to take them stigma dependence
ndash Lack of attention to other aspects of lifestyle that improve overall health and esteem
bull Parents seek other options (30 - 40)
Chan E J Dev Beh Ped 2003Psychopharm Bull 2008 4137-47
Setlick J Pediatrics 2009 124 875-80
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
CDC Data amp Statistics
bull CDCs Summary Health Statistics for US Children National Health Interview Survey 2009 (December 2010 Series 10 Number 247)
bull 21 million children between the ages of 5 to 11 have ADHD (76)
bull 3 million children between the ages of 12 to 17 have ADHD (122)
Epidemiology
bull Prevalence 4-11 in US
bull Boys Girls 31
bull Etiology multifactorial ndash Genetic ndash family history of ADHD
alcoholism sociopathy LD mood and anxiety disorders
ndash Medical (maternal smoking and alcohol use during pregnancy gestational diabetes head injury seizures CNS infection OSAS) and
ndash Environmental risks (lead CO Cd TV) and protective factors (high IQ supportive structured family environment)
ndash Cultural ndash much lower prevalence estimates in Europe and Japan than US
ndash many unknowns
TV and Attention
bull TV viewing accounted for
significant portion of the
variation in ratings of ADHD ss
(Miller CJ 2007)
bull Frequent television viewing
associated with subsequent
attention and school problems
(Johnson JG 2007)
bull No evidence of bidirectionality
between TV time and
AttentionLearning issues
(Johnson JG 2007)
Whatrsquos wrong
with his brain
bull 446 kids with and without ADHD scanned
repeatedly over years
bull ADHD kids lag 3 yrs in cortical growth
bull ADHD motor cortex matures earlier
bull Brain imaging not clinical tool
bull No evidence of abnormality only delay
Shaw P National Academy of Science 2007
bull One physician Dr Michael Anderson of Canton Georgia calls ADHD a ldquomade uprdquo disorder ldquoan excuserdquo for doctors to prescribe Adderall to treat poor academic performance in inadequate schools
bull October 16 2012
CDC Data amp Statistics
CDC Data amp Statistics
bull The prevalence of children 4-17 years of age taking ADHD medication increased from 48 in 2007 to 61 in 2011
CDC REPORTS ECONOMIC COST
bull Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is estimated to be between $12005 and $17458 annually per individual
bull Across 10 countries it was projected that ADHD was associated with 1438 million lost days of productivity each year Most of this loss can be attributed to ADHD and not co-occurring conditions
Ritalin Use in the United StatesEstimated Number of Children Taking
RitalinPrescriptions of Ritalin for attention deficit hyperactivity
disorder have quadrupled in a decade
1970 - 150000
1980 - Between 270000 and 541000
1990 - 900000
2003 - 25 million
2012 ndash 6 million
Medication Challenges
bull Poor responsendash Poor response in 35 (no behavioral improvement)
ndash Side effects gt50 nausea weight loss insomnia tics irritability not himself arryhthmias liver dysfunction
ndash Increase in calls to Poison Control Centers
ndash Failure to take them stigma dependence
ndash Lack of attention to other aspects of lifestyle that improve overall health and esteem
bull Parents seek other options (30 - 40)
Chan E J Dev Beh Ped 2003Psychopharm Bull 2008 4137-47
Setlick J Pediatrics 2009 124 875-80
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Epidemiology
bull Prevalence 4-11 in US
bull Boys Girls 31
bull Etiology multifactorial ndash Genetic ndash family history of ADHD
alcoholism sociopathy LD mood and anxiety disorders
ndash Medical (maternal smoking and alcohol use during pregnancy gestational diabetes head injury seizures CNS infection OSAS) and
ndash Environmental risks (lead CO Cd TV) and protective factors (high IQ supportive structured family environment)
ndash Cultural ndash much lower prevalence estimates in Europe and Japan than US
ndash many unknowns
TV and Attention
bull TV viewing accounted for
significant portion of the
variation in ratings of ADHD ss
(Miller CJ 2007)
bull Frequent television viewing
associated with subsequent
attention and school problems
(Johnson JG 2007)
bull No evidence of bidirectionality
between TV time and
AttentionLearning issues
(Johnson JG 2007)
Whatrsquos wrong
with his brain
bull 446 kids with and without ADHD scanned
repeatedly over years
bull ADHD kids lag 3 yrs in cortical growth
bull ADHD motor cortex matures earlier
bull Brain imaging not clinical tool
bull No evidence of abnormality only delay
Shaw P National Academy of Science 2007
bull One physician Dr Michael Anderson of Canton Georgia calls ADHD a ldquomade uprdquo disorder ldquoan excuserdquo for doctors to prescribe Adderall to treat poor academic performance in inadequate schools
bull October 16 2012
CDC Data amp Statistics
CDC Data amp Statistics
bull The prevalence of children 4-17 years of age taking ADHD medication increased from 48 in 2007 to 61 in 2011
CDC REPORTS ECONOMIC COST
bull Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is estimated to be between $12005 and $17458 annually per individual
bull Across 10 countries it was projected that ADHD was associated with 1438 million lost days of productivity each year Most of this loss can be attributed to ADHD and not co-occurring conditions
Ritalin Use in the United StatesEstimated Number of Children Taking
RitalinPrescriptions of Ritalin for attention deficit hyperactivity
disorder have quadrupled in a decade
1970 - 150000
1980 - Between 270000 and 541000
1990 - 900000
2003 - 25 million
2012 ndash 6 million
Medication Challenges
bull Poor responsendash Poor response in 35 (no behavioral improvement)
ndash Side effects gt50 nausea weight loss insomnia tics irritability not himself arryhthmias liver dysfunction
ndash Increase in calls to Poison Control Centers
ndash Failure to take them stigma dependence
ndash Lack of attention to other aspects of lifestyle that improve overall health and esteem
bull Parents seek other options (30 - 40)
Chan E J Dev Beh Ped 2003Psychopharm Bull 2008 4137-47
Setlick J Pediatrics 2009 124 875-80
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
TV and Attention
bull TV viewing accounted for
significant portion of the
variation in ratings of ADHD ss
(Miller CJ 2007)
bull Frequent television viewing
associated with subsequent
attention and school problems
(Johnson JG 2007)
bull No evidence of bidirectionality
between TV time and
AttentionLearning issues
(Johnson JG 2007)
Whatrsquos wrong
with his brain
bull 446 kids with and without ADHD scanned
repeatedly over years
bull ADHD kids lag 3 yrs in cortical growth
bull ADHD motor cortex matures earlier
bull Brain imaging not clinical tool
bull No evidence of abnormality only delay
Shaw P National Academy of Science 2007
bull One physician Dr Michael Anderson of Canton Georgia calls ADHD a ldquomade uprdquo disorder ldquoan excuserdquo for doctors to prescribe Adderall to treat poor academic performance in inadequate schools
bull October 16 2012
CDC Data amp Statistics
CDC Data amp Statistics
bull The prevalence of children 4-17 years of age taking ADHD medication increased from 48 in 2007 to 61 in 2011
CDC REPORTS ECONOMIC COST
bull Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is estimated to be between $12005 and $17458 annually per individual
bull Across 10 countries it was projected that ADHD was associated with 1438 million lost days of productivity each year Most of this loss can be attributed to ADHD and not co-occurring conditions
Ritalin Use in the United StatesEstimated Number of Children Taking
RitalinPrescriptions of Ritalin for attention deficit hyperactivity
disorder have quadrupled in a decade
1970 - 150000
1980 - Between 270000 and 541000
1990 - 900000
2003 - 25 million
2012 ndash 6 million
Medication Challenges
bull Poor responsendash Poor response in 35 (no behavioral improvement)
ndash Side effects gt50 nausea weight loss insomnia tics irritability not himself arryhthmias liver dysfunction
ndash Increase in calls to Poison Control Centers
ndash Failure to take them stigma dependence
ndash Lack of attention to other aspects of lifestyle that improve overall health and esteem
bull Parents seek other options (30 - 40)
Chan E J Dev Beh Ped 2003Psychopharm Bull 2008 4137-47
Setlick J Pediatrics 2009 124 875-80
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Whatrsquos wrong
with his brain
bull 446 kids with and without ADHD scanned
repeatedly over years
bull ADHD kids lag 3 yrs in cortical growth
bull ADHD motor cortex matures earlier
bull Brain imaging not clinical tool
bull No evidence of abnormality only delay
Shaw P National Academy of Science 2007
bull One physician Dr Michael Anderson of Canton Georgia calls ADHD a ldquomade uprdquo disorder ldquoan excuserdquo for doctors to prescribe Adderall to treat poor academic performance in inadequate schools
bull October 16 2012
CDC Data amp Statistics
CDC Data amp Statistics
bull The prevalence of children 4-17 years of age taking ADHD medication increased from 48 in 2007 to 61 in 2011
CDC REPORTS ECONOMIC COST
bull Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is estimated to be between $12005 and $17458 annually per individual
bull Across 10 countries it was projected that ADHD was associated with 1438 million lost days of productivity each year Most of this loss can be attributed to ADHD and not co-occurring conditions
Ritalin Use in the United StatesEstimated Number of Children Taking
RitalinPrescriptions of Ritalin for attention deficit hyperactivity
disorder have quadrupled in a decade
1970 - 150000
1980 - Between 270000 and 541000
1990 - 900000
2003 - 25 million
2012 ndash 6 million
Medication Challenges
bull Poor responsendash Poor response in 35 (no behavioral improvement)
ndash Side effects gt50 nausea weight loss insomnia tics irritability not himself arryhthmias liver dysfunction
ndash Increase in calls to Poison Control Centers
ndash Failure to take them stigma dependence
ndash Lack of attention to other aspects of lifestyle that improve overall health and esteem
bull Parents seek other options (30 - 40)
Chan E J Dev Beh Ped 2003Psychopharm Bull 2008 4137-47
Setlick J Pediatrics 2009 124 875-80
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
bull One physician Dr Michael Anderson of Canton Georgia calls ADHD a ldquomade uprdquo disorder ldquoan excuserdquo for doctors to prescribe Adderall to treat poor academic performance in inadequate schools
bull October 16 2012
CDC Data amp Statistics
CDC Data amp Statistics
bull The prevalence of children 4-17 years of age taking ADHD medication increased from 48 in 2007 to 61 in 2011
CDC REPORTS ECONOMIC COST
bull Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is estimated to be between $12005 and $17458 annually per individual
bull Across 10 countries it was projected that ADHD was associated with 1438 million lost days of productivity each year Most of this loss can be attributed to ADHD and not co-occurring conditions
Ritalin Use in the United StatesEstimated Number of Children Taking
RitalinPrescriptions of Ritalin for attention deficit hyperactivity
disorder have quadrupled in a decade
1970 - 150000
1980 - Between 270000 and 541000
1990 - 900000
2003 - 25 million
2012 ndash 6 million
Medication Challenges
bull Poor responsendash Poor response in 35 (no behavioral improvement)
ndash Side effects gt50 nausea weight loss insomnia tics irritability not himself arryhthmias liver dysfunction
ndash Increase in calls to Poison Control Centers
ndash Failure to take them stigma dependence
ndash Lack of attention to other aspects of lifestyle that improve overall health and esteem
bull Parents seek other options (30 - 40)
Chan E J Dev Beh Ped 2003Psychopharm Bull 2008 4137-47
Setlick J Pediatrics 2009 124 875-80
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
CDC Data amp Statistics
CDC Data amp Statistics
bull The prevalence of children 4-17 years of age taking ADHD medication increased from 48 in 2007 to 61 in 2011
CDC REPORTS ECONOMIC COST
bull Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is estimated to be between $12005 and $17458 annually per individual
bull Across 10 countries it was projected that ADHD was associated with 1438 million lost days of productivity each year Most of this loss can be attributed to ADHD and not co-occurring conditions
Ritalin Use in the United StatesEstimated Number of Children Taking
RitalinPrescriptions of Ritalin for attention deficit hyperactivity
disorder have quadrupled in a decade
1970 - 150000
1980 - Between 270000 and 541000
1990 - 900000
2003 - 25 million
2012 ndash 6 million
Medication Challenges
bull Poor responsendash Poor response in 35 (no behavioral improvement)
ndash Side effects gt50 nausea weight loss insomnia tics irritability not himself arryhthmias liver dysfunction
ndash Increase in calls to Poison Control Centers
ndash Failure to take them stigma dependence
ndash Lack of attention to other aspects of lifestyle that improve overall health and esteem
bull Parents seek other options (30 - 40)
Chan E J Dev Beh Ped 2003Psychopharm Bull 2008 4137-47
Setlick J Pediatrics 2009 124 875-80
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
CDC Data amp Statistics
bull The prevalence of children 4-17 years of age taking ADHD medication increased from 48 in 2007 to 61 in 2011
CDC REPORTS ECONOMIC COST
bull Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is estimated to be between $12005 and $17458 annually per individual
bull Across 10 countries it was projected that ADHD was associated with 1438 million lost days of productivity each year Most of this loss can be attributed to ADHD and not co-occurring conditions
Ritalin Use in the United StatesEstimated Number of Children Taking
RitalinPrescriptions of Ritalin for attention deficit hyperactivity
disorder have quadrupled in a decade
1970 - 150000
1980 - Between 270000 and 541000
1990 - 900000
2003 - 25 million
2012 ndash 6 million
Medication Challenges
bull Poor responsendash Poor response in 35 (no behavioral improvement)
ndash Side effects gt50 nausea weight loss insomnia tics irritability not himself arryhthmias liver dysfunction
ndash Increase in calls to Poison Control Centers
ndash Failure to take them stigma dependence
ndash Lack of attention to other aspects of lifestyle that improve overall health and esteem
bull Parents seek other options (30 - 40)
Chan E J Dev Beh Ped 2003Psychopharm Bull 2008 4137-47
Setlick J Pediatrics 2009 124 875-80
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
CDC REPORTS ECONOMIC COST
bull Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is estimated to be between $12005 and $17458 annually per individual
bull Across 10 countries it was projected that ADHD was associated with 1438 million lost days of productivity each year Most of this loss can be attributed to ADHD and not co-occurring conditions
Ritalin Use in the United StatesEstimated Number of Children Taking
RitalinPrescriptions of Ritalin for attention deficit hyperactivity
disorder have quadrupled in a decade
1970 - 150000
1980 - Between 270000 and 541000
1990 - 900000
2003 - 25 million
2012 ndash 6 million
Medication Challenges
bull Poor responsendash Poor response in 35 (no behavioral improvement)
ndash Side effects gt50 nausea weight loss insomnia tics irritability not himself arryhthmias liver dysfunction
ndash Increase in calls to Poison Control Centers
ndash Failure to take them stigma dependence
ndash Lack of attention to other aspects of lifestyle that improve overall health and esteem
bull Parents seek other options (30 - 40)
Chan E J Dev Beh Ped 2003Psychopharm Bull 2008 4137-47
Setlick J Pediatrics 2009 124 875-80
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Ritalin Use in the United StatesEstimated Number of Children Taking
RitalinPrescriptions of Ritalin for attention deficit hyperactivity
disorder have quadrupled in a decade
1970 - 150000
1980 - Between 270000 and 541000
1990 - 900000
2003 - 25 million
2012 ndash 6 million
Medication Challenges
bull Poor responsendash Poor response in 35 (no behavioral improvement)
ndash Side effects gt50 nausea weight loss insomnia tics irritability not himself arryhthmias liver dysfunction
ndash Increase in calls to Poison Control Centers
ndash Failure to take them stigma dependence
ndash Lack of attention to other aspects of lifestyle that improve overall health and esteem
bull Parents seek other options (30 - 40)
Chan E J Dev Beh Ped 2003Psychopharm Bull 2008 4137-47
Setlick J Pediatrics 2009 124 875-80
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Medication Challenges
bull Poor responsendash Poor response in 35 (no behavioral improvement)
ndash Side effects gt50 nausea weight loss insomnia tics irritability not himself arryhthmias liver dysfunction
ndash Increase in calls to Poison Control Centers
ndash Failure to take them stigma dependence
ndash Lack of attention to other aspects of lifestyle that improve overall health and esteem
bull Parents seek other options (30 - 40)
Chan E J Dev Beh Ped 2003Psychopharm Bull 2008 4137-47
Setlick J Pediatrics 2009 124 875-80
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Many conditions can be Misdiagnosed as ADHD including
bull Vitamin and Mineral Deficienciesbull Toxic heavy metal excessbull Thyroid problemsbull Food and chemical intolerancesallergiesbull Candidiasisbull Leaky gut syndrome amp Dysbiosis
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Albert Einstein
bull Did you know that Einstein one of the greatest geniuses of the last century did not speak until he was four years old and did not read until he was seven He was described as mentally slow unsociable and adrift in his foolish dreams He was expelled from school and refused admittance to the Zurich Polytech Institute
bull Today he would have been put on RitalinAdderall Concerta Vtvanase etc
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Famous People Who Exhibit ADD Behaviors or Have Been Diagnosed as ADD
bull Hans Christian Anderson Ann Bancroft Beethoven George Burns Harry Belafonte Thomas Carlyle Andrew Carnegie Lewis Carroll Prince Charles Agatha Christie Winston Churchill Admiral Richard Byrd Stephen Hawkins Mariel Hemingway The Wright Brothers Eddie Rickenbacker Ernest Hemingway Bill Cosby John Corcoran Leonardo da Vinci Salvador Dali Dwight D Eisenhower Michael Faraday F Scott Fitzgerald Henry Ford Benjamin Franklin Galileo Danny Glover Steven Hawkins Tracey Gold John F Kennedy ZsaZsa Gabor Micheal Jordan Robert Kennedy Jason Kidd John Lennon Abraham Lincoln Carl Lewis Mozart Napoleon Nasser Issac Newton Picasso Edgar Allan Poe Ronald Reagan Dan Quayle George C Scott John D Rockefeller Eleanor Roosevelt Babe Ruth Nolan Ryan Pete Rose Charles Schwab Steven Spielberg Sylvester Stallone Van Gogh Robin Williams Stevie Wonder
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Many people with ADHD must do things their way
bull Leonardo DaVinci was known for his famous paintings like the Last Supper but numerous of his drawings were found most of which he never completed He wasnrsquot satisfied with the paint he was using so he came up with his own
bull He could have been classified as having ADHD
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
More ADHD Examples
bull The actor and director Kenneth Branagh feared school so much that he tried throwing himself down the stairs to break a leg rather than go
bull Winston Churchill ldquorefused to study mathematics Greek or Latin and was pleased in the lowest formrdquo - what today would be referred to as the resource room where slow boys were taught English
bull Some say that Thomas Edison tried 9999 times to perfect the light bulb and finally did on his 10000th attempt Imagine telling that story to your average ADHD kid who typically gives up if he or she doesnrsquot obtain the desired result after the first attempt
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
More ADHD Examples
bull Gandhi said his school days were the most miserable of his life
bull John Lennon was expelled from kindergarten
bull Woody Allen claims ldquoI paid attention to everything but teachersrdquo
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
WHAT IF THEY WERE ON RITALIN ADDERALL OR DEXEDRINE
bull BEETHOVEN handled the violin awkwardly andpreferred playing his own compositionsinstead of improving his technique Histeacher called him hopeless as a composer
bull SIR ISAAC NEWTON did very poorly in gradeschool
bull LEO TOLSTOY author of War and Peaceflunked out of college He was described asldquoboth unable and unwilling to learnrdquo
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Why is Ritalin so controversial
bull Ritalin is classified as a Schedule II controlled substance This rating is given to prescription drugs that have the greatest abuse and dependence potential Other drugs in this category are Morphine Opium and Cocaine
bull Ritalin is an amphetamine (ldquoSpeedrdquo)
All other ADHD drugs are different versions of SPEED
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Why is Ritalin so controversial
bull According to the Diagnostic amp Statistical Manual of Mental Disorders and the PDR the side effects of Ritalin include
ndash Stunting of growth depression insomnia nervousness skin rash anorexia nausea dizziness abdominal pain psychosis in chronic usage blood pressure and pulse changes tourettersquos syndrome - a permanent and irreversible condition characterized by body ticks spasms barking sounds and screaming obscenities
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
The Side Effects of Ritalin
bull Perhaps the best known effect of chronic stimulant administration is psychosisPsychosis has been associated with chronic use of several stimulants eg d-and 1-amphetamine methylphenidate (Ritalin-P) phenmetrazine and cocaine
bull (from ldquoPredicting Dependence Liability of Stimulant and Depressant Drugsrdquo by Thompson and Unna
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
DRUGS PRESCRIBED FOR ADHD
bull Adderall and Adderall XRbull Concertabull Dexedrinebull Focalin and Focalin XRbull Metadate CD and Metadate ERbull Methylin and Methylin ERbull Ritalin Ritalin SR Ritalin Lbull Stratterabull Vyvansebull Daytranabull Quillivant XR
bull httpwwwwebmdcomad d-adhdguideadhd-medical-treatment
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
IRREVERSIBLE BRAIN CHANGES CAUSED BY STIMULANTS
ldquoIn animals chronically administered high doses of amphetamines [the drugs] produce long-lasting depletion of dopamine alterations in dopamine uptake sites and reduction in serotonergic activity Methamphetamine in particular seems capable of inducing damage to serotonergic fibersIn monkeys the toxic effects of chronic amphetamine use include damage to cerebral blood vessels neuronal loss [brain cell death] and
microhemorrhagesrdquo
Source The Comprehensive Textbook of Psychiatry Jerome Jaffe 1995
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Stimulant Medications and Side-Effects
bull Decreased Appetite
bull Trouble Sleeping
bull Abdominal Pain
bull Headaches
bull Tics
bull Bizarre Behavior
bull Hallucinations (at least 1100)
bull Potential for Addiction -controversial
bull Generally all of these stop when the medication is stopped
bull Stunting of growth
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
More Subtle but ldquoWorrisomerdquo Effects
bull ldquoHersquos just not himselfrdquo
bull ldquoHersquos lost her spark or her joyrdquo
bull ldquoHersquos just not the same kidrdquo
bull Hersquos teary or sad a lot
bull Hersquos not as enthusiastic or creative
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Suspect Drug Strattera
bull Side Effect Completed Suicide
bull This is just one of nearly 600 cases of Canadian kids suffering serious sometimes fatal side effects suspected to have been caused by ADHD medications in the past 10 years
bull (David Bruser 2012 The Toronto Star)
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull Health Canada which collects these adverse reaction reports does not alert the public to the magnitude of these side effects
bull ldquoIt is primarily the (drug companyrsquos) responsibility to monitor the safe use of their productsrdquo Health Canada told the Star
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull The Star also found four deaths that were not suicides including an 18-year-old girl who died after a cerebral hemorrhage in 2011
bull The Star found side effects on most parts of the body mdash the brain respiratory system several major organs blood skin eyes ears and hair including
bull 20 kids had psychotic disordersbull More than 40 kids suffered depression A doctor reported a 15-
year-old felt ldquoworthlessrdquo This teen made aggressive and depressed by two different concurrent doses of Adderall XR hurt himself and thought about killing himself
bull 24 convulsions including a 7-year-old on Adderall XR in 2010bull 48 hallucinations including 11 cases of kids hearing voices In the
antiseptic language of adverse-reaction reporting this side effect is labelled ldquoauditory hallucinationrdquo
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull 20 overdoses eight of those intentional including a 10-year-old boy on Ritalin
bull 3 strokes an 11-year-old boy a 16-year-old boy and an 18-year-old girl also on birth control
bull 28 cases of heart problems including irregular heartbeats blood pressure spikes chest pain and one ventricular fibrillation (severely abnormal heart rhythm) An 8-year-old girl suffered a heart attack
bull 23 cases involving side effects on the liver including a 6-year-old boy on two ADHD drugs with abnormal liver function and a 12-year-old who died in 2007 after developing a liver tumour
bull Other side effects experienced by 7-year-olds include sleep terror emotional disorder moaning convulsion weight loss chest pain muscle twitching intentional self-injury depression staring and fecal incontinence
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
ADHD drugs suspected of hurting Canadian kids (Toronto Star 260912)
bull A long list of very rare but disturbing side effects including increased intracranial pressure muscle coordination problems that made it difficult for kids to walk or speak involuntary and repetitive body movements incoherent talkativeness eyes rolling into the head blindness in a 14-year-old girl on two ADHD drugs rectal hemorrhage angina blisters covering the body twisted neck deafness face swelling a tumourin an 8-year-old girl and growth retardation
bull In each of the 600 reports the youth either went to hospital suffered a disability or life-threatening condition or died
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Ottawa keeps ADHD reports secret (Toronto Star September 28 2012)
bull Health Canada has detailed records of probes into ADHD drug safety including fatalities that it is keeping secret from the public
bull Every six months to a year drug companies submit summaries of side effects suspected to have been caused by their drugs worldwide information Health Canada says it evaluates
bull These summaries called periodic safety update reports are not available to the public
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
ARE THE SIDE EFFECTS WORTH ITDO ADHD DRUGS WORK
bull A study by William Frankenberger and Christine Cannon at the Human Development Center at the University of Wisconsin in Eau Claire published in 1999 found that 13 ADHD children on medication performed progressively worse over four years on standardized tests when compared with a group of 13 normal children with similar IQs and other characteristics
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Links to Ritalin
bull Ritalin use is linked to crime and violence more than any other drug according to a Canadian report
bull Well known criminal defense attorney from Georgia Melvin Nash states that between 50-60 of the people he represents for everything from traffic violations to armed robbery have been on Ritalin at some point in their life
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
QUICK FACTS
There are 7 billion people in the worldOver 330 million of those live in the US and
Canada The US and Canada makes up 30 of the total
population 95 of Ritalin is consumed in the US and Canada If ADD is so prevalent then why does 25 of the
population consume 95 of Ritalin The national average for children on Ritalin in
Canada and the US is 56
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
SCIENCE DAILY
bull One in six college students misuse ADHD stimulant drugs
bull Getting into trouble with drugs is one way to derail a promising future and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses A recent literature review published by researchers at the University of South One in six college students misuse ADHD stimulant drugs
bull Date
bull March 10 2015
bull Source
bull University of South Carolina
bull Summary
bull One in six college students misuse the stimulant drugs prescribed for ADHD such as Ritalin and Adderall considerably more than reported in several of the earlier studies a meta-analysis shows Those students run both legal and health risks in off-prescription use of ADHD stimulant drugs which are Schedule II controlled substances
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
An Integrative Approach
It is important to see the child in the context of his or her family friends school and community and not just as someone with a set of symptoms one is trying to fix
Sometimes a change in the home environment school or teacher is more important than any medicine or herb
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
(httpswwwfacebookcompagesAmerican-Academy-of-Anti-Aging-Medicine-A4M420227435315)
(httptwittercomAnti_AgingNews) (httpwwwlinkedincomgroups
mostPopular=ampgid=1392357) (httppinterestcomworldhealthanti-aging-health-news)
Food for thought - image from Shutterstock (httpthumb101shutterstockcomdisplay_pic_with_logo501730132337193stock-photo-food-for-thought-132337193jpg)
With pharmacological approaches both costly in developed nations and largely inaccessible in developing
countries scientists and public health experts are looking at nutritional approaches to address mental health
issues Jerome Sarris from the University of Melbourne (Australia) and colleagues submit that ldquoEvidence is
steadily growing for the relation between dietary quality (and potential nutritional deficiencies) and mental
health and for the select use of nutrient-based supplements to address deficiencies or as monotherapies or
augmentation therapiesrdquo The team submits that in addition to addressing diet quality there is sufficient
evidence to support the notion of nutrient-based therapies to assist in the management of psychiatric disorders
Studies show that a number of nutrients associate with brain health including omega-3s B vitamins
(particularly folate and B12) choline iron zinc magnesium S-adenosyl methionine (SAMe) vitamin D and
amino acids The study authors urge that ldquoWe advocate recognition of diet and nutrition as central
determinants of both physical and mental healthrdquo
Jerome Sarris Alan C Logan Tasnime N Akbaraly G Paul Amminger Vicent Balanzaacute-Martiacutenez Marlene P Freeman et al
ldquoNutritional medicine as mainstream in psychiatryrdquo The Lancet Psychiatry January 25 2015
Fructose Feeds Diabetes
(newsfructose-feeds-diabetes)
Foods to Ingrain Longevity
The Importance of Nutrition in MentalHealth
Posted on Feb 27 2015 6 am in Mental Health (listnewsmental_health) Diet (listnewsdiet) Dietary
Supplementation (listnewsdietary_supplementation)
VIEW NEWS SOURCEhellip (HTTPMEDICALXPRESSCOMNEWS2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTHHTML)
RELATED STORIES
DIET
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
TYPES OF STRESSINTERFERENCES TO THE NERVOUS SYSTEM
Chemicals ndash Aspartame Splenda NutraSweet smoke alcohol air and water pollutionOther toxins ndash lead cadmium arsenic mercury fluoride aluminum excess copperFoods - sugar grains yeast food allergies or intolerancesDeficiencies ndash vitamin D zinc iron omega-3 magnesium amino acidsDrugs ndash antibiotics amphetamine psychiatric drugsWifi Poor Communication Family Dynamics
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
TOXIC HEAVY METALS
bull Drinking Waterbull Air Pollutionbull Tobacco
bull Fish and Seafoodbull Antiperspirantsbull Heavy Trafficbull Pesticidesbull Fertilizersbull Medications
bull Aluminum Cookwarebull Amalgam Fillings
bull Old Paint
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
A child may be exposed to lead mercury and other neurotoxic chemicals through any of the following
bull Dental amalgam fillings Amalgam fillings are made up of 40 mercury nickel cadmium and copper
bull Paint Although lead is no longer an ingredient in paint these days older buildings may still have paint with lead
bull Mercury from older vaccines when a derivative of mercury was added as a preservative may be a problem Fish are a common source
bull Pesticides including spray used indoorsbull Common household chemicals like nail polish acetone
and perchloroethylene a chemical used in dry cleaning
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Basic Nutrition ndash or ldquoWhen did Pop Tartsbecome a breakfast foodrdquo
bull Maintaining a normal blood sugar
ndash Sugar
ndash Processed Carbohydrates
ndash Protein
bull And the Glycemic Index
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
bull Heres what happens A child eats a breakfast that has no fat no protein and a high glycemic index mdash lets say a bagel with fat-free cream cheese His blood sugar goes up but pretty soon it crashes which triggers the release of stress hormones like adrenaline
bull What youre left with at around 10 am is a kid with low blood sugar and lots of adrenaline circulating in his bloodstream
David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
bull Hes jittery and fidgety and not paying attention Thats going to look an awful lot like ADHD to his teacher
bull The possibility exists that in children predisposed to ADHD quality of diet may have additional impact
bull David Ludwig MD PhD director of the Optimal Weight for Life program at Childrenrsquos Hospital Boston
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Artificial Colors Flavors
and Preservatives
bull 273 three year olds with hyperactivity enrolled in DBPC study
bull Given a diet free of food coloring and preservatives then a daily drink with colorings and sodium benzoate
bull Significant increases in hyperactivity when getting the active mixture
Batteman B Arch Dis Child 2004
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
ADHD and Food Allergy
bull 19 children responded favorably to a
multiple food elimination diet
bull 16 completed a DBPC Food Challenge
bull Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0003)
Boris M Annals of Allergy 1994
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Elimination Diet May Improve ADHD Symptoms
bull February 10 2011 mdash In a group of young children with attention-deficithyperactivity disorder (ADHD) nearly two-thirds who followed a restricted elimination diet experienced a significant reduction in ADHD symptoms and oppositional defiant behavior Going off the diet led to relapse
bull Investigators Suggest Diet Therapy Should Be Considered in All Children With ADHD
bull Lancet 2011377446-448 494-503
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
ADHD and Food Allergy
bull 6276 children treated with an Oligoantigenicdiet improved
bull 2862 who improved completed a DBPCFT -foods thought to provoke symptoms were reintroduced Symptoms worse on active foods than placebo 48 foods were incriminated
bull Artificial colorants and preservatives were the most common provoking substances
Egger J Lancet 1985
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Elimination Diets
bull ldquoFeingold hypothesisrdquo
ndash Children are sensitive to dietary salicylates and artificially added colors flavors and preservatives
ndash Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Elimination Diets
bull At least 8 controlled studies have demonstrated significant improvement (welimination diet) compared to a placebo condition or deterioration after introducing offending substances
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
ADHD and Food Allergy
bull 19 children responded favorably to a multiple food elimination diet
bull 16 then completed a DBPC Food Challenge
bull Symptoms improved significantly on days given placebo rather than foods they were sensitive to (P=0003)
bull Annals of Allergy 72(5)462-8 1994 May
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
How do You Test for Food Sensitivities
bull Single Food Elimination
bull Multiple Food Elimination
bull Allergy Testing ndash IgE or IgG (Gamma Dynacare ndash 905-790-3000)
bull ALCAT
bull ELISAAct
bull Electrodermal (Interro Vega etc)
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Basic Rules of Nutrition
Each person is different
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
One manrsquos meat
is another manrsquos poison
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Food allergies are common
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Basic Rules of Nutrition
Eat whole foods
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Why whole foods
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Why whole foods
More vitamins and minerals
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Losses of Vitamins in Refining of Flour
Thiamine 77
Riboflavin 80
Niacin 81
Vitamin B6 72
Pantothenate 50
Folic acid 67
Vitamin E 86
Betaine 23
Choline 30
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Losses of Minerals in Refining of Flour
Magnesium 85
Calcium 60
Potassium 77
Chromium 40
Manganese 86
Iron 76
Copper 68
Zinc 78
Selenium 16
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Why whole foods
More fiber
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Why whole foods
Accessory food factors
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Whole Grains
bull Vitamins
bull Minerals
bull Essential fatty acids
bull Fiber
bull Associated with
reduced risk of
diabetes stroke and
heart disease and
increased longevity
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Beans (legumes)
bull Improve blood-glucose
regulation
bull Lower serum cholesterol
bull Form ldquocomplete proteinrdquo
when combined with grain
in 13 ratio (dry weight)
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Vegetables
bull Vitamins minerals
EFAs carotenoids
bull Fiber
bull Associated with
reduced risk of heart
disease cancer and
many other diseases
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Cruciferous Vegetables(brassicas)
bull Broccoli
bull Brussels sprouts
bull Cabbage
bull Cauliflower
bull Turnip
bull Kale
bull Collard
bull Radish
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Onion
bull Source of quercetin
bull Antihypertensive
bull Increases fibrinolytic
activity
bull Inhibits platelet
aggregation
bull Prevents experimental
atherosclerosis
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Tomato
bull Major food source of
lycopene
bull Prevention and possible
treatment of prostate cancer
bull Antihypertensive inhibits
platelet aggregation
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Spinach
bull Increases plasma
antioxidant activity
bull May reduce risk of age-
related macular degeneration
bull High in oxalate increases
urinary oxalate excretion
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Fruit
bull High in potassium
flavonoids vitamin C and
other nutrients
bull Contains fiber
bull Associated with reduced
risk of heart disease cancer
stroke osteoporosis
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Pigments in MampMrsquos
bull Yellow 5 Lake
bull Red 40 Lake
bull Blue 1 Lake
bull Yellow 6 Lake
bull Blue 2 Lake
bull Blue 1
bull Blue 2
bull Red 40
bull Yellow 5
bull Yellow 6
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Blueberry
bull Anthocyanosides promote
tissue integrity and play a role
in visual function
bull A component of blueberry
(proanthocyanidins) inhibits
binding of uropathogenic E
coli to cells lining urinary tract
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Cranberry
bull Prevention of UTIs
bull Proanthocyanidins inhibit
binding of pathogenic E coli to
uroepithelial cells
bull Natural antibiotic (hippuric acid)
bull Urinary acidification
bull Eliminates typical
schizophrenic body odor
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Olives
bull Monounsaturated fatty acids
bull Phenolic antioxidants
(oleuropein hydroxytyrosol vanillic
acid verbascoside)
bull Phenolics inhibit platelet
aggregation LDL oxidation
production of inflammatory
eicosanoids
bull Ibuprofen-like activity
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Extra-Virgin Olive
Oil
Oleuropein hydroxytyrosol
vanillic acid and
verbascoside which are
present in extra-virgin olive
oil are almost completely
absent in refined olive oil
which is extracted with
solvents
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Nuts
bull Contain protein EFAs fiber
magnesium arginine
bull Lower serum cholesterol may
lower blood pressure
bull Associated with reduced risk of
cardiovascular disease diabetes
bull Do not appear to cause obesityEat lsquoem raw
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Meat
bull Protein iron and other
minerals B vitamins carnitine
bull Cholesterol saturated fat
bull High-temperature cooking
produces cholesterol oxides
AGEs and carcinogens
bull Top of the food chain
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Fish
bull Protein omega-3 fatty acids
and other nutrients
bull May reduce risk of
cardiovascular disease
bull Fish oil beneficial for a wide
range of conditions
bull Top of the food chain source
of mercury and other toxins
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Milk
bull Protein calcium vitamin D
and other nutrients
bull Frequently allergenic
bull May promote type 1 diabetes
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Eggs
bull High-quality protein
choline lutein other nutrients
bull Minimal effect on serum
cholesterol in most individuals
bull No increase in risk of heart
disease except in diabetics
bull Scrambling may produce
oxidized cholesterol
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Aspartame
Symptoms associated with ingestion
include
Headaches Convulsions
Eye pain Depression
Loss of vision Anxiety
Chest pain Diarrhea
Palpitations Urinary frequency
Joint pain Edema
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Plastics The Sixth Food Group
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Individually wrapped for
maximum surface contact
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Some Endocrine Disrupting Chemicals
that Leach from Plastic Bottles
Phthalate esters
p-Nonyl-phenol
Bisphenol A
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Effects of Endocrine Disrupters
Cancer Diabetes Sperm abnormalities
Miscarriage Autoimmune disease
Premature breast development
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Donrsquot forget the kids
Polycarbonate bottles leach bisphenol-A
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
What about Water
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Tap Water
bull Pipes potential source
of copper lead
bull Additives
bull Chlorine
bull Aluminum
bull Fluoride
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
What about supplements
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Rationale for Nutrient Therapy
1 Compensation for a deficient diet
2 Increased requirements resulting from
a) disease
b) medications
c) stress and environmental factors
d) biochemical individuality
3 Pharmacological effects
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Drug-induced nutritional deficiencies
bull Thiazideloop diuretics (Mg+2 K+ thiamine zinc)
bull Alcohol (multiple deficiencies)
bull Caffeine (magnesium calcium)
bull Antacidsacid blockers (may reduce absorption of vitamin B12 calcium
iron folic acid and other nutrients)
bull Anticonvulsants (may cause deficiencies of folic acid vitamin D biotin)
bull Statins (may deplete coenzyme Q10)
bull Oral contraceptives (may deplete folic acid vitamin B6 other nutrients)
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Stress depletes magnesium
Various stressors (noise sleep deprivation type A
personality) result in magnesium depletion
Magnesium deficiency aggravates the deleterious effects
of stress (eg hypertension gastric ulceration myocardial
damage noise-induced hearing loss)
Artery 19819205-11 J Am Coll Nutr 19854165-72 Am J Otolaryngol 19941526-32 Clin
Cardiol 199720265-8 Magnesium 19865201-10 Magnesium Deficiency First Eur Congr
Magnesium Lisbon 1983 (Karger Basel 1985)24-9
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Nutrients and Air Pollution
Vitamins C and E attenuated the
adverse effect of ozone on lung
function of asthmatics
Arch Environ Health 200156242-9
Am J Respir Crit Care Med 2002166703-9
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Symptoms of Mg deficiency
Fatigue Memory loss
Anxiety Intestinal complaints
Weakness Headaches
Chest pain Lightheadedness
Dyspnea Poor stress tolerance
Muscle cramps Insomnia
Palpitations Lump in throat
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Omega-3 Fatty Acids
bull Omega-3 FArsquos are polyunsaturated meaning they
contain more than one double bond
bull They are called omega-3 because the first double
bond counting from the methyl end of the fatty acid
is located at the third carbon atom
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Omega-3 Fatty AcidsTypes
bull Alpha-linolenic acid (ALA)
bull Eicosapentaenoic acid (EPA)
bull Docosahexaenoic acid (DHA)
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Alpha-linolenic Acid
bull Humans can synthesize other omega-3 fatty acids from ALA
bull Eicosapentaenoic acid (EPA) 205n-3
bull Docosahexaenoic acid (DHA) 226n-3
bull These two are usually referred to as marine-derivedomega-3 fatty acids because they are abundant in certain species of fish
bull Whereas ALA is considered a plant-derived omega-3 fatty acid
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Omega-3rsquos ADHD and LD
bull 41 Children with ADHD and LD given a Omega-3rsquos for 12 weeks or a placebo
bull After 12 weeks children in the treatment group had significant improvement in their ADHD scores compared to placebo
Progress in Neuro-Psychopharmacology amp Biological Psychiatry (2002)
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Omega 3 Fat DHA May Benefit Those with ADHD
bull The children aged 7-12 randomly received the omega 3 fats (EPA and DHA) or safflower oil (omega-6) for a period of four months While there were no significant differences among the groups the increased amount of omega 3 fats in particular DHA was associated with improved reading and behavior Among 17 children with learning disabilities there were improvements in reading spelling behavior attention and hyperactivity
bull The authors of the study conclude that increases in DHA may improve reading and behavior especially in those children who also have learning difficulties
bull Nutrition 2012 Jun28(6)670-7
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products such as EPA and DHA (fish oil fats)
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Inefficient Conversion of ALA (Flax Oil) To EPA and DHA
bull It appears that children with ADHD just are not able to chemically convert the plant omega-3 ALA to fish oil very well The problem is further worsened when omega-6 fats are consumed and the ideal omega-63 ratio of 11 progresses to the typical standard American ratio of 151 Many of these children have ratios which are even worse and can be as high as 501
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
SYMPTOMS SUGGESTING A POSSIBLE NEED FOR ESSENTIAL FATTY ACIDS
bull Dry flaking skinbull ldquoChicken skinrdquo or bumps on the outer upper
arms thighs or cheeksbull Brittle soft or splitting fingernailsbull Nails with longitudinal linesbull Dry hairbull Dry scaling in the ear canalbull ADHD DEPRESSION ANXIETY
bull Eczemabull Asthma
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Essential fatty acids for
ADHDbull 41 kids RCT to EPA 186 mg + DHA 480 mg +
GLA 96 mg + cis-linoleic acid 864 vs placebo mg daily for 12 weeks EFA lowered Conners scores
Richardson 2002
bull Oxford-Durham RCT of fatty acids supplrsquos for 117 children with developmental coordination disorder ldquosignificant improvements for active treatment vs placebo were found in reading spelling and behavior over 3 months of treatment in parallel groups After the crossover similar changes were seen in the placebo-active grouprdquo
Richardson Pediatrics 2005
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Magnesium
bull French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
ndash 30 52 hyperactive children had low ERC-Mg values
ndash Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
ndash ldquoIn all patients symptoms of hyperexcitability (physical
aggressivity instability scholar attention hypertony spasm
myoclony) were reduced after 1 to 6 months treatment Other
family members shared similar symptoms had low ERC-Mg
values and also responded clinically to increased
Mg(2+)vitamin B6 intakes ldquo
ndash MORE STUDIES NEEDED May help anxiety
Mousain-Bosc M Am J Clin Nutr 2004
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Flax oil and vitamin C supplements
improve ADHD
bull 30 kids with ADHD compared with 30 normal kids in clinic in India
bull Supplement with 200 mg ALA + 25 mg Vitamin C twice a day for 3 months
bull All kids had more EFA in RBC cell membranes after 3 months
bull ADHD kids had (Plt001) improvements in total hyperactivity score self-control psychosomatic restlessness inattention impulsivity social problems learning problems
Joshi K Prostaglandins Leukot Essent Fatty Acids 2006
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
VITAMIN D DEFICIENCY OFTEN MISDIAGNOSED AS ADHD
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Smoking and ADHD
bull Research shows that smoking while pregnant will increase the possibility of having an ADD child by four times Ohio has the highest incidence of mothers smoking while they are pregnant 56
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
ANTIBIOTICS ANDDEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of1 and 12 years linked developmental delays (DD) in children andthe amount of antibiotics they have taken According to a reportissued by the Developmental Delay Registry (DDR) in SilverSpring MD
Those who have taken more than 20 cycles of antibiotics in their lifetimeare over 50 more likely to experience developmental delays
Source ADVANCE for speech amp language pathologists and audiologists May 1995
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull SUGARndash One can of soda has 11 tsp of sugar which weakens the immune
system by 30
bull CAFFEINE (coffee tea soft drinks energy drinks chocolate bars)ndash Adversely affects brain chemistry
bull COWrsquoS MILKndash FDA allows the residue of up to 60 different antibiotics plus growth
hormonesndash Remember cowrsquos milk is for calves
bull HYDROGENATED OILS amp TRANS FATTY ACIDSndash Replaces essential fatty acids in cell membranes of your brain causing
the cells to leak function poorly or not at all
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull EDTAndash A preservative that causes kidney damage and
calcium imbalances
bull MSGndash Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of the brain
bull NUTRASWEET (ASPARTAME)ndash A very poisonous neurotoxin
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull BHTBHAndash Preservative - weakens the immune system
bull ARTIFICIAL COLORINGndash Some are known carcinogens many create allergic
reactions that affect brain chemistry
bull PROPYLENE GLYCOLndash Food additive that is also used to de-ice airplanes
bull SODIUM NITRITEndash Used to cure meat a known carcinogen
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
DIETARY FOODS AND TOXIC SUBSTANCES TO AVOID
bull PESTICIDESndash Buy organic
bull ANTIBIOTICSndash Kills healthy intestinal flora and thus weakens the immune system
bull OVER THE COUNTER DRUGSndash Aspirin Tylenol Advil etc - all suppress white blood cells and
therefore weaken the immune system Causes intestinal bleeding kidney and liver damage
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull Skin rashes
bull Behavior problems ADHD Learning problems
bull Chronic headaches
bull Intestinal complaints
bull Fatigue lethargy weakness
bull Depression
bull Irritability and easy anger
bull Anxiety
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
Problems thinking clearly or remembering
Muscle aches
Insomnia
Hyperactivity
Asthma
Recurrent infections of ear nose bladder etc
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
HEALTH COMPLAINTS ASSOCIATED WITH YEAST-RELATED COMPLEX (YRC)
bull A change in the balance of intestinal flora can
weaken the mucus lining of the intestines
bull Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining
bull affecting the area of the brain that controls
mood and emotion thus causing depression
bull irritability and many other health problems
bull Source Is This Your Child By Dr Doris Rapp
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Fatigue
Irritability
Mood swings
Muscle twitches
Wiggly legs
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
COMMON SYMPTOMS OF
HYPOGLYCEMIA (low blood sugar)
Headaches
Problems concentrating
Dizziness
Anxiety
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Nutritional Supplements
bull Amino Acid Supplementation
ndash Reportedly low levels of amino acids in ADHD
ndash Short-term benefit for tryptophan 5-HTP tyrosine GABA Theanine or phenyalanine
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
L-Theanine
bull Preliminary studies suggest theanine may indirectly reduce ADHD hyperactivity by promoting a sense of relaxation and enhancing the release of dopamine
bull The Trends in Food Science amp Technology journal outlines a human study saying theaninecreated an increase in alpha waves which are brain waves associated with relaxation This increase in alpha waves indicates theanine may help relieve hyperactivity without causing drowsiness
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
GABA
bull A study which was conducted in Kyorin University Medical School in Japan used a natural form of GABA named PharmaGABA
bull There were 60 participants who were given either 100mg of the GABA supplement or a placebo after which they administered a math test
bull Those who were given GABA have provided 20 more answers in general and got more correct answers than the placebo group This result proved that GABA increases mental ability
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
MAGNESIUM GLYCINATE
bull Magnesium relaxes the mind The body uses magnesium to facilitate sending messages throughout our nervous system Magnesium is also used to calm the nervous system which is doubly important in children with hyperactivity disorders With the right amount of magnesium present in the body children can think clearer and concentrate better Magnesium is also a key factor in the production of serotonin an important neurotransmitter that provides a feeling of calm and well-being Low levels of serotonin are associated with irritability moodiness and depression
bull Magnesium relaxes the body Magnesium is essential for the relaxation of muscle fibers Without this essential mineral spasms and twitches are a common problem Magnesium helps muscles in the body relax and function properly without disturbances When the body feels calm it is easier for hyperactive children to behave calmly
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Nutritional Supplements
bull Iron Supplementationndash Open 30-day trial with 17 non-anemic ADHD boys improvement in
parents Connersrsquo scores (Sever et al 1997)
bull Zinc supplementationndash Little research
bull Magnesium Supplementationndash 50 kids with ADHD and magnesium deficiency 6 months significant
decrease in parent and teacher Conners scoresndash Magnesium glycinate is best for absorption and limited bowel side
effectsndash Magnesium oxide or citrate better for constipation in lieu of ER visits
enemas and mineral oil
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Zinc in ADHD
bull Zinc levels predict stimulant
response(Arnold 1990)
bull Serum zinc levels low in ADHD
(Bekaroglu 1996)
bull Zinc effective as supplement to stimulant
(Akhondzadeh 2004)
bull Zinc effective in reducing hyperactive and
impulsive behavior (Bilici 2005)
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Zinc in ADHD
bull RCT of Zinc supplements for 209 7th graders
bull Dose 0 10 or 20 mg Zinc 5xwk for 10 Weeks
bull Statistical improvement in 20mg group (no
improvement with lower doses)
Study presented at Experimental Biology meeting April 4 2005 at San Diego CA by James
Penland Ph D
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
ADHD and Iron Deficiency
bull Fifty-three children with ADHD and 27 controls
bull The mean serum ferritin levels were lower in the children with ADHD (mean plusmn SD 23 plusmn 13 ngmL) than in the controls (mean plusmn SD 44 plusmn 22 ngmL P lt 001)
bull Arch Pediatr Adolesc Med 2004
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Iron in ADHD
bull Iron plays a key role in dopamine metabolism
bull Low ferritin levels associated with more hyperactivity in ADHD patients (Oner 2008)
bull 84 of ADHD pts had abnormally low ferritin levels (Konofal et al Arch Pediatr Adolesc Med 2004)
bull Iron improved Connorrsquos ratings (Sever 1997)
bull Iron treatment for ADHD reduced ADHD rating scale and CGI at 12 weeks (Konofal 2008)
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Melatonin in ADHD
bull RCT in 25 children with ADHD and chronic sleep onset insomnia melatonin 5 mg daily at 6pm vs placebo
bull Melatonin significantly improved sleep onset decreased sleep latency and increased total sleep time
bull No change in ADHD behavior over 4 weeks but all kids kept using it for one year
Smits J Neurology Neurosurg Psychiatry 1999
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
American ginseng and Ginkgo for
ADHD
bull Open trial among 36 children 3-17 yo
bull Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
bull Connors parents scale
ndash 2 weeks 31 improved on anxiousshy 67
improved on psychosomatic
ndash 4 weeks 74 improved on Connersrsquo ADHD
Index
Lyon et al J Psychiatry Neurosci 2001
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Behavioral Approaches
bull Can be effective with or without medication
bull Often history is good year-bad year good-year-bad year Why Great teachers
bull Kids with ADHD need structure firm limits and lots of positive reinforcement
bull What if an entire school could have that kind of approach
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St Johnrsquos wort
Blue-green algae
Ginkgo (Ginkgo biloba)
Oligomeric proanthocyanidin (OPCs Pycnogenol)
Valerian (Valeriana officinalis)
Lemon balm (Melissa officinalis)
Kava (Piper methysticum)
Chamomile (Matricaria recutita)
Passion flower (Passiflora incarnata)
Hops (Humulus lupulus)
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
OTHER TREATMENTS
bull Chinese Herbalsndash Chinese herbal cocktail compared to methylphenidate
ndash Significant improvement rates comparable to stimulate meds but more improvement on IQ scores and fewer side effects
ndash Need placebo-controlled double-blind studies
bull Acupuncturendash Little data on its efficacy
ndash Loo (1998) found decreases on parent and teacher Connersbull Noted that kids with most severe ADHD could not comply with tx
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Sleep and ADHD
bull Children with ADHD have much higher rates
of sleep problems parasomnias and sleep
disordered breathing
bull Polysomnography in 33 (3-16 yo) with
ADHD 24 had obstructive sleep apnea
30 had periodic limb
movementsCompared with ADHD as
whole= more obese
Goroya JS Pediatric Neurology 2009Li S 2008
Mayes SD 2008
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Meditation
bull Mental training that can regulate attention and brain training
bull Research in non-clinical samples has shown improvements on attentional blink tests
bull Rationale for using mindfulness meditation with ADHD can impact symptoms of inattention and impulsivity associated neurocognitive deficits of inhibition and help with stress anxiety and depression
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Mindful Meditation
bull 3 steps ndash bringing attention to an ldquoattentional anchorrdquo (usually a
sensory input such as a breathndash Noting that distraction occurs and letting go of distractionndash Refocusing or reorienting attention back to the ldquoattentional anchorrdquo
bull Pilot Study (Zylowska et al 2007)ndash 8 week mindful meditation group w adults amp adolescentsndash Prendashpost improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and cognitive inhibition
ndash Next steps controlled clinical study
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Placebo Effects
bull Placebo effects well documented in psychiatry
bull Parents and teachers tend to evaluate kids
more positively if they think they are medicated
bull Parents and teachers tend to attribute positive
changes to medications even when no meds
are givenWaschbusch DA J Dev Behav Pediatr 2009
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Further reading on fructose
Gaby AR Adverse effects
of dietary fructose Altern
Med Rev 200510294-
306
Gaby AR Sucrose and
high-fructose corn syrup
In Gaby AR Nutritional
Medicine Concord NH
2011
wwwdoctorgabycom
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
Take Home Message
bull We need to be careful not to over- diagnose ADHD
bull When we do make the diagnosis I believe we should seriously consider at least exploring non-pharmaceutical options which are certainly safe and may be effective before beginning psychostimulants
