Adhd march 2015

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Autism, ADD, Learning Disorders
KIDS ON DRUGS? – There’s a Better
Approach to ADHD
by Dr. Zoltan P. Rona, MD, M.Sc.
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http://vitalitymagazine.com/article/kid
s-on-drugs/

ADHD Symptoms
• Inattention
1. Easily distracted
2. Forgetful
3. Loses things
4. Difficulty sustaining
attention
5. Avoid/dislike difficult
tasks
6. Difficulty organizing
7. Careless mistakes
8. Doesn’t listen
9. Difficulty following
instructions
• Hyperactive/Impulsiv
e
1. Fidgety
2. Difficulty staying in seat
3. Runs or climbs
excessively Hyper
feeling
4. Acts on the go/ driven
by a motor
5. Difficulty doing things
quietly
6. Talks excessively
7. Difficulty waiting turn
8. Blurts out answers
9. Interrupts/intrudes

Differential Diagnosis
• Vision and hearing problems
• Chronic illness with itch; breathing impairment, e.g.,
sleep apnea; sleep problems
• Developmental or learning problems; language
deficits
• Absence seizures
• Acute change in living situation, grief, family conflict,
recent trauma
• Substance abuse; side effect of medications
• Stress
• FREQUENT CO-MORBIDITIES (Other mood or
anxiety disorder; psychotic disorder; adjustment
disorder) fixing them can solve most of the problem
(next slide)

ADHD: Comorbidity
• Learning Disability: 37-50%
• Anxiety: 20 to 33%
• Depression: 10 to 20%
• Bipolar: 63 to 92% of Pediatric BPD also
meets criteria for ADHD
• OCD: 40%
• Conduct Disorder: 20%
• Tourettes/Tics:7%

CDC Data & Statistics
• CDC's Summary Health Statistics for U.S.
Children: National Health Interview Survey,
2009 (December 2010; Series 10, Number
247)
• 2.1 million children between the ages of 5 to
11 have ADHD (7.6%)
• 3 million children between the ages of 12 to
17 have ADHD (12.2%)

Epidemiology:
• Prevalence: 4-11% in US
• Boys: Girls, 3:1
• Etiology: multifactorial
– Genetic – family history of ADHD,
alcoholism, sociopathy, LD, mood and
anxiety disorders
– Medical (maternal smoking and alcohol
use during pregnancy; gestational
diabetes; head injury; seizures; CNS
infection; OSAS), and
– Environmental risks (lead, CO, Cd, TV)
and protective factors (high IQ, supportive,
structured family environment)
– Cultural – much lower prevalence
estimates in Europe and Japan than US
– many unknowns

TV and Attention
• TV viewing accounted for
significant portion of the
variation in ratings of ADHD s/s
(Miller CJ, 2007)
• Frequent television viewing
associated with subsequent
attention and school problems
(Johnson JG, 2007)
• No evidence of bidirectionality
between TV time and
Attention/Learning issues
(Johnson JG, 2007)

What’s wrong
with his brain?
• 446 kids with and without ADHD scanned
repeatedly over years
• ADHD kids lag 3 yrs in cortical growth
• ADHD: motor cortex matures earlier
• Brain imaging not clinical tool
• No evidence of abnormality, only delay
Shaw P. National Academy of Science. 2007

• One physician, Dr. Michael Anderson of
Canton, Georgia, calls ADHD a “made up”
disorder, “an excuse” for doctors to prescribe
Adderall to treat poor academic performance
in inadequate schools.
• October 16, 2012

CDC Data & Statistics
• The prevalence of children 4-17
years of age taking ADHD
medication increased from 4.8% in
2007 to 6.1% in 2011

CDC REPORTS ECONOMIC COST
• Using a prevalence rate of 5%, the annual societal
‘‘cost of illness’’ for ADHD is estimated to be
between $36 and $52 billion, in 2005 dollars. It is
estimated to be between $12,005 and $17,458
annually per individual.
• Across 10 countries, it was projected that ADHD
was associated with 143.8 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 States
Estimated Number of Children Taking
Ritalin
Prescriptions of Ritalin for attention deficit hyperactivity
disorder have quadrupled in a decade
1970 - 150,000
1980 - Between 270,000 and 541,000;
1990 - 900,000,
2003 - 2.5 million
2012 – 6 million

Medication Challenges
• Poor response
– Poor response in 35% (no behavioral improvement)
– Side effects >50%: nausea, weight loss, insomnia, tics,
irritability, not himself; arryhthmias, liver dysfunction
– Increase in calls to Poison Control Centers
– Failure to take them; stigma; dependence
– Lack of attention to other aspects of lifestyle that improve overall
health and esteem
• Parents seek other options (30% - 40%)
Chan E. J Dev Beh Ped, 2003
Psychopharm Bull 2008; 41:37-47
Setlick, J Pediatrics 2009; 124: 875-80

Many conditions can be Misdiagnosed
as ADHD, including:
• Vitamin and Mineral Deficiencies
• Toxic heavy metal excess
• Thyroid problems
• Food and chemical intolerances/allergies
• Candidiasis
• Leaky gut syndrome & Dysbiosis

Albert Einstein
• 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.
• Today, he would have been
put on Ritalin/Adderall,
Concerta, Vtvanase, etc..

Famous People Who Exhibit ADD Behaviors or
Have Been Diagnosed as ADD
• 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, Zsa
Zsa 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

Why is Ritalin so controversial?
• 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.
• Ritalin is an amphetamine (“Speed”)
All other ADHD drugs are different versions of
SPEED

Why is Ritalin so controversial?
• According to the Diagnostic & Statistical Manual of
Mental Disorders and the PDR, the side effects of Ritalin
include:
– Stunting of growth, depression, insomnia, nervousness,
skin rash, anorexia, nausea, dizziness, abdominal pain,
psychosis in chronic usage, blood pressure and pulse
changes, tourette’s syndrome - a permanent and
irreversible condition characterized by body ticks, spasms,
barking sounds, and screaming obscenities.

The Side Effects of Ritalin
• Perhaps the best known effect of chronic
stimulant administration is psychosis.
Psychosis has been associated with
chronic use of several stimulants; e.g. d-
and 1-amphetamine methylphenidate
(Ritalin-P), phenmetrazine and cocaine.
• (from “Predicting Dependence Liability of Stimulant and
Depressant Drugs” by Thompson and Unna

DRUGS PRESCRIBED FOR ADHD
• Adderall and Adderall XR
• Concerta
• Dexedrine
• Focalin and Focalin XR
• Metadate CD and Metadate ER
• Methylin and Methylin ER
• Ritalin, Ritalin SR, Ritalin L
• Strattera
• Vyvanse
• Daytrana
• Quillivant XR
• http://www.webmd.com/ad d-adhd/guide/adhd-medical-treatment

IRREVERSIBLE BRAIN CHANGES
CAUSED BY STIMULANTS
“In 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 fibers...In monkeys the toxic effects of chronic
amphetamine use include damage to cerebral blood
vessels, neuronal loss [brain cell death], and
microhemorrhages.”
Source: The Comprehensive Textbook of Psychiatry, Jerome Jaffe, 1995

Stimulant Medications and Side-Effects
• Decreased Appetite
• Trouble Sleeping
• Abdominal Pain
• Headaches
• Tics
• Bizarre Behavior
• Hallucinations (at least 1:100)
• Potential for Addiction -controversial
• Generally, all of these stop when the medication is stopped
• Stunting of growth

More Subtle but “Worrisome” Effects
• “He’s just not himself”
• “He’s lost her spark, or her joy”
• “He’s just not the same kid”
• He’s teary, or sad a lot
• He’s not as enthusiastic or creative.

ADHD drugs suspected of hurting
Canadian kids (Toronto Star 26/09/12)
• Suspect Drug: Strattera
• Side Effect: Completed Suicide
• 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.
• (David Bruser, 2012, The Toronto Star)

ADHD drugs suspected of hurting Canadian kids
(Toronto Star 26/09/12)
• Health Canada, which collects these adverse
reaction reports, does not alert the public to
the magnitude of these side effects.
• “It is primarily the (drug company’s)
responsibility to monitor the safe use of their
products,” Health Canada told the Star.

• The Star also found four deaths that were not suicides, including an
18-year-old girl who died after a cerebral hemorrhage in 2011.
• The Star found side effects on most parts of the body — the brain,
respiratory system, several major organs, blood, skin, eyes, ears,
and hair, including:
• 20 kids had psychotic disorders
• More than 40 kids suffered depression. A doctor reported a 15-
year-old felt “worthless.” This teen, made aggressive and depressed
by two different, concurrent doses of Adderall XR, hurt himself and
thought about killing himself.
• 24 convulsions, including a 7-year-old on Adderall XR in 2010.
• 48 hallucinations, including 11 cases of kids hearing voices. In the
antiseptic language of adverse-reaction reporting, this side effect
is labelled “auditory hallucination.”

• 20 overdoses, eight of those intentional, including a 10-year-old boy
on Ritalin.
• 3 strokes: an 11-year-old boy; a 16-year-old boy; and an 18-year-old
girl also on birth control
• 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.
• 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.
• 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.

• 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 tumour
in an 8-year-old girl and growth retardation.
• 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)
• Health Canada has detailed records of probes
into ADHD drug safety, including fatalities,
that it is keeping secret from the public.
• 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.
• These summaries, called periodic safety
update reports, are not available to the public.

ARE THE SIDE EFFECTS WORTH IT?
DO ADHD DRUGS WORK?
• 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
• Ritalin use is linked to crime and
violence more than any other drug,
according to a Canadian report.
• 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 world.
 Over 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 5.6%.

SCIENCE DAILY
• One in six college students misuse ADHD stimulant drugs
• 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
• Date:
• March 10, 2015
• Source:
• University of South Carolina
• Summary:
• 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.

Food for thought - image from Shutterstock (http://thumb101.shutterstock.com/display_pic_with_logo/501730/132337193/stock-photo-food-for-thought-
132337193.jpg)
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: “Evidence 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 therapies.” 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: “We advocate recognition of diet and nutrition as central
determinants of both physical and mental health.”
The Importance of Nutrition in Mental
Health
Posted on Feb. 27, 2015, 6 a.m. in Mental Health (/list/news/mental_health/) Diet (/list/news/diet/) Dietary
Supplementation (/list/news/dietary_supplementation/)
VIEW NEWS SOURCE… (HTTP://MEDICALXPRESS.COM/NEWS/2015-01-DIET-NUTRITION-ESSENTIAL-MENTAL-HEALTH.HTML)

TYPES OF STRESS/INTERFERENCES TO
THE NERVOUS SYSTEM
Chemicals – Aspartame, Splenda, NutraSweet, smoke,
alcohol, air and water pollution
Other toxins – lead, cadmium, arsenic, mercury, fluoride,
aluminum; excess copper
Foods - sugar, grains, yeast, food allergies or
intolerances
Deficiencies – vitamin D, zinc, iron, omega-3,
magnesium, amino acids
Drugs – antibiotics, amphetamine,. psychiatric drugs
Wifi,
Poor Communication,
Family Dynamics

TOXIC HEAVY METALS
• Drinking Water
• Air Pollution
• Tobacco
• Fish and Seafood
• Antiperspirants
• Heavy Traffic
• Pesticides
• Fertilizers
• Medications
• Aluminum Cookware
• Amalgam Fillings
• Old Paint

A child may be exposed to lead, mercury, and other
neurotoxic chemicals through any of the following:
• Dental amalgam fillings. Amalgam fillings are made up
of 40% mercury, nickel, cadmium, and copper.
• Paint. Although lead is no longer an ingredient in paint
these days, older buildings may still have paint with
lead.
• Mercury from older vaccines, when a derivative of
mercury was added as a preservative, may be a
problem. Fish are a common source.
• Pesticides, including spray used indoors.
• Common household chemicals like nail polish, acetone,
and perchloroethylene, a chemical used in dry
cleaning.

Basic Nutrition – or “When did Pop Tarts
become a breakfast food?”
• Maintaining a normal blood sugar
– Sugar
– Processed Carbohydrates
– Protein
• And the Glycemic Index

• Here's what happens: A child eats a breakfast that
has no fat, no protein, and a high glycemic index
— let's 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.
• What you're left with, at around 10 a.m., is a kid
with low blood sugar and lots of adrenaline
circulating in his bloodstream.
David Ludwig, M.D., Ph.D., director of the Optimal Weight for
Life program at Children’s Hospital Boston

• He's jittery and fidgety and not paying
attention. That's going to look an awful lot
like ADHD to his teacher.
• The possibility exists that in children predisposed to
ADHD, quality of diet may have additional impact.
• David Ludwig, M.D., Ph.D., director of the Optimal Weight
for Life program at Children’s Hospital Boston

Weapons of Mass Destruction
High in sugar
Nutrient-depleted
Fiber-depleted
Oxidized fats
Trans fatty acids
Additives

Artificial Colors, Flavors,
and Preservatives
• 273 three year olds with hyperactivity
enrolled in DBPC study
• Given a diet free of food coloring and
preservatives, then a daily drink with
colorings and sodium benzoate.
• Significant increases in hyperactivity when
getting the active mixture.
Batteman B. Arch Dis Child. 2004

ADHD and Food Allergy
• 19 children responded favorably to a
multiple food elimination diet.
• 16 completed a DBPC Food Challenge.
• Symptoms improved significantly on days
given placebo rather than foods they were
sensitive to (P=0.003)
Boris M. Annals of Allergy, 1994

Elimination Diet May Improve ADHD
Symptoms
• February 10, 2011 — In a group of young children
with attention-deficit/hyperactivity 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.
• Investigators Suggest 'Diet Therapy" Should Be
Considered in All Children With ADHD
• Lancet. 2011;377:446-448, 494-503.

• 62/76 children treated with an Oligoantigenic
diet improved.
• 28/62 who improved completed a DBPCFT -
foods thought to provoke symptoms were
reintroduced. Symptoms worse on active foods
than placebo. 48 foods were incriminated.
• Artificial colorants and preservatives were the
most common provoking substances.
Egger J. Lancet. 1985

Elimination Diets
• “Feingold hypothesis”
– Children are sensitive to dietary salicylates and
artificially added colors, flavors, and preservatives
– Learning and behavior problems (including ADHD)
can be reduced or eliminated by removing these
substances

Elimination Diets
• At least 8 controlled studies have
demonstrated significant
improvement (w/elimination diet)
compared to a placebo condition, or
deterioration after introducing
offending substances

• 19 children responded favorably to a multiple food
elimination diet.
• 16 then completed a DBPC Food Challenge.
• Symptoms improved significantly on days given
placebo rather than foods they were sensitive to
(P=0.003)
• Annals of Allergy. 72(5):462-8, 1994 May

How do You Test for Food Sensitivities?
• Single Food Elimination
• Multiple Food Elimination
• Allergy Testing – IgE or IgG (Gamma
Dynacare – 905-790-3000)
• ALCAT
• ELISA/Act
• ???/Electrodermal (Interro, Vega, etc.)

Basic Rules of Nutrition
Each person is different.

One man’s meat . . .
. . . is another man’s poison.

Basic Rules of Nutrition
Eat 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?
Accessory food factors

Accessory Food Factors
Flavonoids Carotenoids
Polyphenols Glucosinolates
Indoles Isoflavones
Oligosaccharides Sterols
Saponins Quinones
Hippuric acid Biochanin A
Peptides Phosphatides

Whole Grains
• Vitamins
• Minerals
• Essential fatty acids
• Fiber
• Associated with
reduced risk of
diabetes, stroke, and
heart disease, and
increased longevity

Beans (legumes)
• Improve blood-glucose
regulation
• Lower serum cholesterol
• Form “complete protein”
when combined with grain
in 1:3 ratio (dry weight)

Vegetables
• Vitamins, minerals,
EFAs, carotenoids
• Fiber
• Associated with
reduced risk of heart
disease, cancer, and
many other diseases

Cruciferous Vegetables
(brassicas)
• Broccoli
• Brussels sprouts
• Cabbage
• Cauliflower
• Turnip
• Kale
• Collard
• Radish

Onion
• Source of quercetin
• Antihypertensive
• Increases fibrinolytic
activity
• Inhibits platelet
aggregation
• Prevents experimental
atherosclerosis

Tomato
• Major food source of
lycopene
• Prevention and possible
treatment of prostate cancer
• Antihypertensive; inhibits
platelet aggregation

Spinach
• Increases plasma
antioxidant activity
• May reduce risk of age-
related macular degeneration
• High in oxalate; increases
urinary oxalate excretion

Fruit
• High in potassium,
flavonoids, vitamin C, and
other nutrients
• Contains fiber
• Associated with reduced
risk of heart disease, cancer,
stroke, osteoporosis

Pigments in M&M’s
• Yellow 5 Lake
• Red 40 Lake
• Blue 1 Lake
• Yellow 6 Lake
• Blue 2 Lake
• Blue #1
• Blue #2
• Red #40
• Yellow #5
• Yellow #6

Blueberry
• Anthocyanosides promote
tissue integrity and play a role
in visual function
• A component of blueberry
(proanthocyanidins?) inhibits
binding of uropathogenic E.
coli to cells lining urinary tract

Cranberry
• Prevention of UTIs
• Proanthocyanidins inhibit
binding of pathogenic E. coli to
uroepithelial cells
• Natural antibiotic (hippuric acid)
• Urinary acidification
• Eliminates typical
schizophrenic body odor

Olives
• Monounsaturated fatty acids
• Phenolic antioxidants
(oleuropein, hydroxytyrosol, vanillic
acid, verbascoside)
• Phenolics inhibit platelet
aggregation, LDL oxidation,
production of inflammatory
eicosanoids.
• 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
• Contain protein, EFAs, fiber,
magnesium, arginine
• Lower serum cholesterol, may
lower blood pressure
• Associated with reduced risk of
cardiovascular disease, diabetes
• Do not appear to cause obesityEat ‘em raw

Meat
• Protein, iron and other
minerals, B vitamins, carnitine
• Cholesterol, saturated fat
• High-temperature cooking
produces cholesterol oxides,
AGEs, and carcinogens
• Top of the food chain

Fish
• Protein, omega-3 fatty acids,
and other nutrients
• May reduce risk of
cardiovascular disease
• Fish oil beneficial for a wide
range of conditions
• Top of the food chain: source
of mercury and other toxins

Milk
• Protein, calcium, vitamin D,
and other nutrients
• Frequently allergenic
• May promote type 1 diabetes

Eggs
• High-quality protein;
choline, lutein, other nutrients
• Minimal effect on serum
cholesterol in most individuals
• No increase in risk of heart
disease, except in diabetics
• 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?

Don’t forget the kids
Polycarbonate bottles leach bisphenol-A

Tap Water
• Pipes: potential source
of copper, lead
• Additives
• Chlorine
• Aluminum
• Fluoride

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
• Thiazide/loop diuretics (Mg+2, K+, thiamine, zinc)
• Alcohol (multiple deficiencies)
• Caffeine (magnesium, calcium)
• Antacids/acid blockers (may reduce absorption of vitamin B12, calcium,
iron, folic acid, and other nutrients)
• Anticonvulsants (may cause deficiencies of folic acid, vitamin D, biotin)
• Statins (may deplete coenzyme Q10)
• 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 (e.g., hypertension, gastric ulceration, myocardial
damage, noise-induced hearing loss).
Artery 1981;9:205-11; J Am Coll Nutr 1985;4:165-72; Am J Otolaryngol 1994;15:26-32; Clin
Cardiol 1997;20:265-8; Magnesium 1986;5:201-10; 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 2001;56:242-9
Am J Respir Crit Care Med 2002;166:703-9

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
• Omega-3 FA’s are polyunsaturated, meaning they
contain more than one double bond
• 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 Acids
Types
• Alpha-linolenic acid (ALA)
• Eicosapentaenoic acid (EPA)
• Docosahexaenoic acid (DHA)

Alpha-linolenic Acid
• Humans can synthesize other omega-3 fatty acids from ALA:
• Eicosapentaenoic acid (EPA): 20:5n-3
• Docosahexaenoic acid (DHA): 22:6n-3
• These two are usually referred to as marine-derived
omega-3 fatty acids because they are abundant in
certain species of fish
• Whereas, ALA is considered a plant-derived omega-3 fatty
acid

Omega-3’s, ADHD, and LD
• 41 Children with ADHD and LD given a Omega-
3’s for 12 weeks or a placebo.
• After 12 weeks, children in the treatment
group had significant improvement in their
ADHD scores compared to placebo.
Progress in Neuro-Psychopharmacology
& Biological Psychiatry (2002)

Omega 3 Fat DHA May Benefit Those with
ADHD
• 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.
• The authors of the study conclude that increases in DHA
may improve reading and behavior, especially in those
children who also have learning difficulties.
• Nutrition. 2012 Jun;28(6):670-7

Inefficient Conversion of ALA
(Flax Oil) To EPA and DHA
• 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
• 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-6:3 ratio of 1:1, progresses to the
typical standard American ratio of 15:1.
Many of these children have ratios which
are even worse and can be as high as
50:1.

SYMPTOMS SUGGESTING A POSSIBLE
NEED FOR ESSENTIAL FATTY ACIDS
• Dry, flaking skin
• “Chicken skin” or bumps on the outer upper
arms, thighs, or cheeks
• Brittle, soft, or splitting fingernails
• Nails with longitudinal lines
• Dry hair
• Dry scaling in the ear canal
• ADHD, DEPRESSION, ANXIETY
• Eczema
• Asthma

Essential fatty acids for
ADHD
• 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.
• Oxford-Durham RCT of fatty acids suppl’s for
117 children with developmental coordination
disorder: “significant 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 group.”
Richardson. Pediatrics, 2005

Magnesium?
• French study evaluated magnesium and B6 in 52 ADHD
kids and relatives
– 30 / 52 hyperactive children had low ERC-Mg values
– Open label supplementation with 100 mg daily of Mg and B6 for
3-24 weeks
– “In 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. “
– MORE STUDIES NEEDED; May help anxiety
Mousain-Bosc M, Am J Clin Nutr, 2004

Flax oil and vitamin C supplements
improve ADHD
• 30 kids with ADHD, compared with 30 normal kids in
clinic in India
• Supplement with 200 mg ALA + 25 mg Vitamin C twice a
day, for 3 months
• All kids had more EFA in RBC cell membranes after 3
months
• ADHD kids had (P<0.01) 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
• 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 AND
DEVELOPMENTAL DELAY
A nationwide survey of nearly 700 children between the ages of
1 and 12 years linked developmental delays (DD) in children and
the amount of antibiotics they have taken. According to a report
issued by the Developmental Delay Registry (DDR) in Silver
Spring, MD:
 Those who have taken more than 20 cycles of antibiotics in their lifetime
are over 50% more likely to experience developmental delays.
Source: ADVANCE for speech & language pathologists and audiologists, May 1995

DIETARY FOODS AND TOXIC
SUBSTANCES TO AVOID
• SUGAR
– One can of soda has 11 tsp. of sugar, which weakens the immune
system by 30%
• CAFFEINE (coffee, tea, soft drinks, energy drinks,
chocolate bars)
– Adversely affects brain chemistry
• COW’S MILK
– FDA allows the residue of up to 60 different antibiotics plus growth
hormones.
– Remember, cow’s milk is for calves!
• HYDROGENATED OILS & TRANS FATTY ACIDS
– Replaces essential fatty acids in cell membranes of your brain, causing
the cells to leak, function poorly or not at all

SUBSTANCES TO AVOID
• EDTA
– A preservative that causes kidney damage and
calcium imbalances
• MSG
– Preservative found to damage the retina of infant
rats and destroy nerve cells in the hypothalamus of
the brain
• NUTRASWEET (ASPARTAME)
– A very poisonous neurotoxin

SUBSTANCES TO AVOID
• BHT/BHA
– Preservative - weakens the immune system
• ARTIFICIAL COLORING
– Some are known carcinogens; many create allergic
reactions that affect brain chemistry
• PROPYLENE GLYCOL
– Food additive that is also used to de-ice airplanes
• SODIUM NITRITE
– Used to cure meat, a known carcinogen

SUBSTANCES TO AVOID
• PESTICIDES
– Buy organic
• ANTIBIOTICS
– Kills healthy intestinal flora and thus weakens the immune system
• OVER THE COUNTER DRUGS
– 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)
• Skin rashes
• Behavior problems, ADHD, Learning problems
• Chronic headaches
• Intestinal complaints
• Fatigue, lethargy, weakness
• Depression*
• Irritability and easy anger
• Anxiety

 Problems thinking clearly or remembering
 Muscle aches
 Insomnia
 Hyperactivity
 Asthma
 Recurrent infections of ear, nose, bladder, etc.

• A change in the balance of intestinal flora can
weaken the mucus lining of the intestines.
• Toxins from the yeast can therefore enter the
blood through the damaged intestinal lining,
• affecting the area of the brain that controls
mood and emotion, thus causing depression,
• irritability and many other health problems.
• 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
• Amino Acid Supplementation
– Reportedly low levels of amino acids in ADHD
– Short-term benefit for tryptophan, 5-HTP,
tyrosine, GABA, Theanine or phenyalanine

L-Theanine
• Preliminary studies suggest theanine may
indirectly reduce ADHD hyperactivity by
promoting a sense of relaxation and enhancing
the release of dopamine.
• The "Trends in Food Science & Technology"
journal outlines a human study saying theanine
created 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
• A study which was conducted in Kyorin University
Medical School in Japan used a natural form of
GABA named PharmaGABA .
• There were 60 participants who were given
either 100mg of the GABA supplement or a
placebo after which they administered a math
test.
• 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
• 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.
• 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
• Iron Supplementation
– Open 30-day trial with 17 non-anemic ADHD boys, improvement in
parents Conners’ scores (Sever et al., 1997)
• Zinc supplementation
– Little research
• Magnesium Supplementation
– 50 kids with ADHD and magnesium deficiency; 6 months; significant
decrease in parent and teacher Conners scores
– Magnesium glycinate is best for absorption and limited bowel side
effects
– Magnesium oxide or citrate better for constipation in lieu of ER visits,
enemas and mineral oil

Zinc in ADHD
• Zinc levels predict stimulant
response(Arnold, 1990)
• Serum zinc levels low in ADHD
(Bekaroglu, 1996)
• Zinc effective as supplement to stimulant
(Akhondzadeh, 2004)
• Zinc effective in reducing hyperactive and
impulsive behavior (Bilici, 2005)

Zinc in ADHD
• RCT of Zinc supplements for 209 7th graders
• Dose: 0, 10 or 20 mg Zinc 5x/wk for 10 Weeks
• 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
• Fifty-three children with ADHD and 27 controls.
• The mean serum ferritin levels, were lower in the
children with ADHD (mean ± SD, 23 ± 13 ng/mL) than
in the controls (mean ± SD, 44 ± 22 ng/mL; P < .001),
• Arch Pediatr Adolesc Med. 2004

Iron in ADHD
• Iron plays a key role in dopamine metabolism
• Low ferritin levels associated with more
hyperactivity in ADHD patients (Oner, 2008)
• 84% of ADHD pts had abnormally low ferritin
levels (Konofal et al, Arch. Pediatr. Adolesc. Med. 2004)
• Iron improved Connor’s ratings (Sever, 1997)
• Iron treatment for ADHD reduced ADHD rating
scale and CGI at 12 weeks (Konofal, 2008)

Melatonin in ADHD
• RCT in 25 children with ADHD and chronic
sleep onset insomnia; melatonin 5 mg daily
at 6pm vs. placebo
• Melatonin significantly improved sleep
onset; decreased sleep latency and
increased total sleep time
• 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
• Open trial among 36 children, 3-17 yo
• Panax quinquefolium (200 mg) + Ginkgo biloba
(50 mg) BID X 4 weeks
• Connors parents scale
– 2 weeks: 31% improved on anxious/shy; 67%
improved on psychosomatic
– 4 weeks: 74% improved on Conners’ ADHD
Index
Lyon, et al. J Psychiatry Neurosci, 2001

Behavioral Approaches
• Can be effective, with or without medication
• Often history is good year-bad year, good-
year-bad year. Why? Great teachers!
• Kids with ADHD need structure, firm limits,
and lots of positive reinforcement.
• What if an entire school could have that kind
of approach?

Common Herbs Used for ADHD
Rhodiola Rosea
Siberian ginseng
St. John’s 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
• Chinese Herbals
– Chinese herbal cocktail compared to methylphenidate
– Significant improvement rates comparable to stimulate
meds, but more improvement on IQ scores and fewer side
effects
– Need placebo-controlled, double-blind studies
• Acupuncture
– Little data on its efficacy
– Loo (1998) found decreases on parent and teacher
Conners
• Noted that kids with most severe ADHD could not comply with tx

Sleep and ADHD
• Children with ADHD have much higher rates
of sleep problems, parasomnias, and sleep
disordered breathing.
• Polysomnography in 33 (3-16 yo) with
ADHD: 24% had obstructive sleep apnea;
30% had periodic limb
movements;Compared with ADHD as
whole= more obese
Goroya JS. Pediatric Neurology, 2009
Li S, 2008
Mayes SD, 2008

Meditation
• Mental training that can regulate attention
and brain training?
• Research in non-clinical samples has shown
improvements on attentional blink tests
• 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
• 3 steps:
– bringing attention to an “attentional anchor” (usually a
sensory input such as a breath
– Noting that distraction occurs and letting go of distraction
– Refocusing or reorienting attention back to the
“attentional anchor”
• Pilot Study (Zylowska et al., 2007)
– 8 week mindful meditation group w/ adults & adolescents
– Pre–post improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and
cognitive inhibition
– Next steps: controlled clinical study

Placebo Effects
• Placebo effects well documented in psychiatry
• Parents and teachers tend to evaluate kids
more positively if they think they are medicated
• Parents and teachers tend to attribute positive
changes to medications even when no meds
are given
Waschbusch, DA J Dev Behav Pediatr 2009

Further reading on fructose
Gaby AR. Adverse effects
of dietary fructose. Altern
Med Rev 2005;10:294-
306.
Gaby AR. Sucrose and
high-fructose corn syrup.
In Gaby AR. Nutritional
Medicine. Concord NH,
2011.
www.doctorgaby.com.

Take Home Message
• We need to be careful not to over- diagnose
ADHD.
• 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 march 2015

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