by Leyla Muedin, MS, RD, CDN
Attention
Deficit/Hyperactivity Disorder is a condition whose principal
characteristics are inattention, hyperactivity and impulsivity. ADHD is
usually diagnosed in children where the primary symptoms are difficulty
controlling behavior and/or paying attention. According to the National
Institutes of Health (NIH), it is estimated that approximately 2 million
children in the United States have ADHD. This means in a classroom of
25 to 30 children, one will likely have ADHD. It affects all races and
cultures, and boys are three times more likely to be diagnosed than
girls.
How do we know it's ADHD?
Not everyone
who is impulsive, hyperactive or inattentive has ADHD. Actually, ADHD is
not easy to diagnose, especially when inattentiveness such as
daydreaming is the primary symptom. It is when a child's
distractibility, hyperactivity, poor concentration, or impulsivity
affects performance in school, behavior at home or in social
relationships with other children that ADHD may be suspected. The
diagnosis of ADHD requires that such behavior be demonstrated to a
degree that is inappropriate for the individual's age.
Approximately
20 to 30 percent of children with ADHD have a learning disability. In
preschool years, these disabilities may present as difficulty
understanding words or sounds and/or difficulty in self-_expression. As
children grow up, this can manifest as spelling or reading disabilities,
and writing or arithmetic disorders.
Research estimates that
between 30 and 70 percent of children with ADHD continue to exhibit
symptoms in adulthood. For many, symptoms of ADHD do not become apparent
until adulthood. Typically adults are unaware that they even have the
disorder. They just feel that it's almost impossible to get organized,
keep an appointment or stick to a job. Distractibility, restlessness and
impulsivity are often the characteristic symptoms in adults. Some may
have a history of school failures, problems at work, or have been
involved in frequent car accidents.
Scientists are now moving
toward looking for a physiological basis for ADHD. Lately, an area of
attention is the brain, particularly the frontal lobes of the cerebrum.
This area of the brain allows us to restrain our impulses, solve
problems, and plan ahead. The left and right frontal lobes communicate
with each other through the corpus callosum (nerve fibers). The basal
ganglia are the interconnected gray masses in the cerebral hemisphere
that connect the cerebrum and the cerebellum which, together are
responsible for motor coordination. These parts of the brain have been
studied through various imaging methods such as the functional magnetic
resonance imaging (fMRI), positron emission tomography (PET-scan), and
single photon emission computed tomography (SPECT). A study conducted in
2002 of 152 boys and girls with ADHD showed a 3 to 4 percent smaller
brain volume in all regions; the frontal lobes, cerebellum, and temporal
gray matter. (It is important to note that these imaging techniques
remain research tools and cannot be used to diagnose ADHD in
individuals.)
Catecholamines/neurotransmitters
Speaking
of the brain, one area of focus in Intelligent Medicine and Nutrition
is on deficiencies of the all important catecholamines. The
catecholamines are dopamine, norepinephrine and epinephrine (commonly
known as adrenaline). These "cats", so cleverly termed by author Julia
Ross, M.A., also function as neurotransmitters. Catecholamines arouse
and excite us mentally, emotionally and physically, and help us to focus
and be attentive. They keep us alert to the important events taking
place around and within us so we can act quickly and decisively. These
"cats" are said to be sleeping in an individual with ADHD. Low calorie,
high carb diets cause catecholamine depletion due to inadequate protein
intake. Our brains need amino acids from high protein foods such as eggs
and salmon. Additionally, protein rich animal foods are high in the
crucial amino acid
tyrosine.
For example, there are about 900 milligrams of tyrosine in a chicken
breast, 840 milligrams in three scrambled eggs, and 400 milligrams in a 4
ounce hamburger, but you would have to eat 24 almonds to get a scant
150 milligrams of tyrosine. Unfortunately, vegetable protein cannot
compete. Vegetarians run the risk of catecholamine deficiency due to the
typical low-protein nature of the diet. In fact, soy, a mainstay of a
vegetarian diet, tends to inhibit the conversion of tyrosine into the
catecholamines. Depletion of other micronutrients such as the
B vitamiins,
calcium,
magnesium, and vitamins
C and
D also contribute to the problem. They are critical to adequate catecholamine function.
Perplexingly,
some kids and adults with ADHD show features of both catecholamine
insufficiency as well as catecholamine surges, made worse by
hypoglycemia. This leads to a state of imbalance in the involuntary
nervous system-something we call dysautonomia.
External and internal toxins
Environmental
toxins from heavy metals such as lead, mercury and cadmium are
certainly not to be overlooked in investigating and treating the causes
of ADHD. Leaky gut from dysbiosis can initiate food allergies (most
commonly to cow's milk, wheat, corn, yeast, soy and eggs) as well as
inhalant allergies---often a significant factor in many children
diagnosed with ADHD. The noted allergist Dr. Doris J. Rapp points out a
fascinating group of physical characteristics common among children with
allergies, including red cheeks, red ears or ear lobes, dark or red
circles or wrinkles under the eyes, and a horizontal crease in the nose
that develops from what she calls the "allergic salute," when a child
with a runny nose rubs his nose upward with the heel of his hand.
The
usual suspect initiators of leaky gut syndrome which usually precede
food allergies are gluten and/or candida. Candida overgrowth is often
the "master control" for food allergies, as well as a source of
neuroactive endotoxins which can make kids feel "stoned." Other
neurotoxins are MSG, aspartame (NutraSweet), and food colorings and
additives. These can perpetuate ADHD symptoms to such peaks as to deem
an individual behaviorally abnormal. Children appear to be particularly
susceptible as their little bodies may be overwhelmed by "normal" doses
of these toxins that are packaged in such innocuous substances as
breakfast cereal and juice boxes. Detoxifying diets such as The Feingold
Program which removes artificial flavors, colors, preservatives and
salicylates often bring about a significant decrease in symptoms, if not
total abatement. Improved behavior can be observed in as little as one
to six weeks (
www.feingold.org).
Helpful supplements to optimize nutrition status, initiate
detoxification, and address the deficiencies associated with ADHD are
essential fatty acids (EFAs) such as
Coromega or
Orthomega (importance of this is discussed below),
magnesium,
calcium,
probiotics,
olive leaf,
Pectasol,
l-glutamine,
B complex,
vitamin C,
theanine,
phospatidyl choline,
phosphatidyl serine,
zinc,
B6 and its metabolite
P5P (pyridoxal 5 phosphate).
Essential fatty acids are of critical importance in growth and brain metabolism. EFAs are present in cold-water fish and
fish oils and in some vegetable sources such as flaxseed oil,
borage
and evening primrose oils. Studies have indicated that some children
with ADHD have an altered fatty acid metabolism. EFAs, particularly
DHA
is critical in brain development and IQ. Deficiencies of EFAs are
associated with allergies, asthma, dry skin and hair, eczema, growth
retardation and delayed puberty. Children on frequent antibiotic
treatment for recurrent ear infections may develop EFA deficiencies.
Supplementation as described above is beneficial.
The sugar/hypoglycemia connection
Pizza,
bread, rice, French fries, spaghetti, sugared high-carbohydrate
breakfast cereals and juice drinks are common dietary staples among
young children. Not to mention the usual sweet treats children enjoy.
Many children survive the sugar onslaught without discernable behavioral
issues but a smaller percentage of these children may be susceptible to
behavioral reactions like powerful mood swings and physiological
sensations as a result of their (and their parent's!) chosen fuel. The
oversecretion of insulin in response to eating these foods causes
hypoglycemia which then sets off the adrenals to secrete epinephrine in
an effort to restore blood sugar levels. This is a major hormonal wallop
for kids causing them to go bouncing off the walls on a hypoglycemic
roller coaster ride.
The short list of symptoms of hypoglycemia
includes weakness, fatigue, spaciness and an inability to concentrate.
In adults, this hormonal cascade can cause symptoms ranging from short
attention span to a full blown panic attack.
For children and
adults, restabilization of blood sugar is mandatory and includes tossing
the refined "junk" carbohydrate food and drinks (a great opportunity to
make a donation to your local food bank), and incorporating high
quality protein and fat at every meal. For the very symptomatic, five to
six smaller meals every two to three hours throughout the day is
therapeutic. I have patients who undergo personality changes if they
don't strictly adhere to this regimen. Supplements to complement a
therapeutic diet in achieving stable blood sugar levels are
chromium,
l-glutamine,
GPLC,
5-HTP and
tyrosine (to wipe out stubborn cravings),
B complex, and
Wellbetx PGX.
Current
mainstream medical management of ADHD includes the use of stimulants
such as Adderall, Ritalin, Concerta, Dexedrine, Focalin, Cylert, and
Metadate. Stimulants primarily work on the neurotransmitter dopamine. A
recent addition to the list that is not a stimulant is Strattera. This
medication works on norepinephrine. What these drugs do is
physiologically push the individual into the normal range of behavior by
rendering the individual more able to focus on one activity at a time.
What these medications do not do is address the underlying problems that
may be causing the abnormal behavior. It is important to remember that
many of these drugs have side effects such as reduced appetite (not good
for a growing child!), headaches, and trouble falling asleep. It is
worth noting that the NIH recommends that Cylert not be considered a
first-line drug therapy due to its potential serious side effects
affecting the liver.
Given the options offered by both
complementary and mainstream medicine, there is much to be said for
"first do no harm" where natural therapies are undertaken prior to
falling back on more powerful but side effect-causing medications. True
successful outcomes with symptom resolution can be brought about by
first uncovering the underlying cause(s) of ADHD in the individual
patient, and then implementing the least harmful, most beneficial
treatment.
References:
1. National Institutes of
Health/National Institute of Mental Health (On-line). Attention Deficit
Hyperactivity Disorder (2003). Accessed May 5, 2006. Available at:
www.nimh.nih.gov/publicat/adhd.cfm http://www.nimh.nih.gov/publicat/adhd.cfm.
2. Ross, J. The Mood Cure. New York, NY: Penguin Putnam; 2002.
3.
Boris M, Mandel FS. Foods and additives are common causes of the
attention deficit hyperactive disorder in children. Annals of Allergy.
1994;72:462-8.
4. Hoffman, RL. The Natural Approach to Attention Deficit Disorder (ADD). Los Angeles, CA: Keats Publishing; 1997.
Leyla Muedin is a clinical nutritionist and lecturer at the Hoffman
Center and is available for speaking engagements for private and public
sector wellness programs. Please call (212) 779-1744 for more
information.
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