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Attention Deficit Hyperactivity Disorder (ADHD - ADD) and Autism
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Diet
Specific dietary tactics including avoiding allergenic foods, reducing sugar intake, and increasing consumption of foods rich in vitamins and minerals have been shown to help control Attention Deficit Hyperactivity Disorder ADHD-ADD in children and adults.

Allergenic Foods
Food allergies are a common, though controversial area of concern for people with ADHD.  Oligoantigenic (few-foods) diets for ADHD have convincing double-blind evidence of efficacy (Egger et al. 1985); however, they appear to be most effective in children, not adults (Arnold 2001). In brief, a non-allergenic diet involves eliminating many foods considered allergenic. The theory that certain foods are allergenic and cause health problems such as ADHD is based on the premise from evolutionary medicine that foods which are the most genetically altered from wild foods on which we evolved are the most likely to cause allergies.

The most widely known proponent of the allergenic theory of ADHD is Benjamin Feingold, M.D., who suggested that food additives in particular are to blame, including artificial colors, flavor enhancers, thickeners, bleaching and anti-caking agents, and preservatives (such as MSG). Research has indeed shown that food dyes can cause irritability, restlessness, and sleep disturbances (Rowe et al. 1994) while other food additives can cause similar symptoms (Boris et al. 1993). Other commonly allergenic foods and food products, such as wheat, oranges, soy, milk, corn, and eggs, are also often eliminated. An elimination diet involves systematically eliminating one possible food allergen at a time to see whether a specific food is causing ADHD.

Sugar
Sugar is certainly the single most damaging food linked to ADHD and a variety of other disorders.  The sudden release in insulin and drop in blood glucose caused by refined sugar intake (reactive hypoglycemia) rapidly raises adrenaline causing a fight or flight response and the aggressive behavior, hyperactivity, and attention problems found in ADHD (Wender et al. 1991).  Children with ADHD also experience abnormal rhythms in regard to the stress hormone cortisol, which often occurs in people who have problems metabolizing carbohydrates (Kaneko et al. 1993; Wolraich et al. 1994). Girardi et al. (1995) found that, upon sugar feeding, people with ADHD release only half the catecholamines (adrenal hormones such as norepinephrine and epinephrine that counterbalance a rapid drop in glucose due to high insulin) as controls. Girardi et al. (1995) also noted that PET scans of children with ADHD showed much less brain activity due to insufficient glucose and tests indicated worse cognitive performance.

In addition, many of the children with ADHD became more hyperactive following the glucose intake in an effort to trigger their adrenal glands to produce more catecholamines. Finally, the most recent studies also show that ADHD is linked to catecholamine dysfunction and energy disorders in brain neurons because it is improved by medications that enhance catecholamine function (Todd et al. 2001). The results of this and other studies on sugar and ADHD emphasize the importance of well-balanced meals rich in protein and complex carbohydrates, which raise catecholamine levels and control fluctuations in glucose.

Poor Nutrition
Optimal levels of certain nutrients, which are often hard to obtain in a normal diet, are crucial in preventing and treating ADHD. In addition, deficiencies of certain nutrients during the critical period of brain formation can lead to permanent damage that may be linked to ADHD in later life. Since 90% of total brain growth takes place during the first 3 years of life, it is essential to provide high-quality building blocks, through diet or supplementation, during this period. Poor nutrition affects the development of the brain during this period and can have damaging effects that may lead to ADHD (Scrimshaw et al. 1968). Early studies show that children who lack optimal amounts of essential nutrients experience reduced attention span and intellectual ability (Crook 1980). Unfortunately, a U.S. Department of Agriculture (USDA) dietary survey of 3300 U.S. children and adolescents showed that less than 1% meets the recommended daily requirements for the five food groups and 16% do not meet any of the requirements (Munoz et al. 1997).

Nutritional Supplements
Numerous studies suggest that people with ADHD may be deficient in specific nutrients and that in some cases, supplementation may improve some of the symptoms of the disorder.

Essential Fatty Acids
Essential fatty acids (EFAs) are the most important nutrients to consider in the battle against ADHD.  For example, one study found that a deficiency of long-chain polyunsaturated fatty acids is linked to ADHD (Richardson et al. 2000a, b). Another study found that deficiencies in highly unsaturated fatty acids (HUFAs) cause the symptoms of ADHD.  After 12 weeks of supplementation with HUFAs, researchers found major improvements in ADHD-related symptoms in children with specific learning difficulties such as dyslexia (Richardson et al. 2002).

Some ADHD diagnoses might be EFA deficiencies in disguise. One study found that ADHD patients reporting symptoms indicative of EFA deficiency had significantly lower levels of plasma arachidonic acid (AA) and docosahexaenoic acid (DHA) than did ADHD patients without these symptoms or controls. In this study patients with low omega-3 fatty acid levels had more temper-tantrums and learning, health, and sleep problems than those with high levels of these fatty acids (Burgess et al. 2000).  DHA supplementation has proven helpful in people with ADHD (Voigt et al. 2001).  DHA can be found in deep-sea, cold-water fatty fish, such as salmon, herring, and tuna; sea vegetables (which is where fish obtain DHA); and micro-algae.  Supplements are derived from these sources.  Linoleic and linolenic acids found in products such as flax and hempseed oil are precursors of DHA and AA, but their manufacture in the body can be blocked by saturated and trans fats.

Phosphatidylserine
Phosphatidylserine (PS - found in Cognitex below) is a natural extract of lecithin and a phospholipid that is vital to brain cell structure and function.  Phospholipids are molecules with an amino acid component and a fatty acid component which are found in every cell membrane in our bodies.  ADHD, dyslexia, dyspraxia, and autism are now considered "phospholipid disorders" because phospholipids are so important in the natural history, symptoms, and prevalence of these conditions which aggregate within families (Richardson et al. 2000a,b).  PS plays an important role in neurotransmitter systems, brain metabolism levels, and maintaining nerve connections in the brain.  PS helps lower cortisol levels that are increased in chronically stressed individuals and improves brain cell membrane fluidity, which helps with dementia and depression.  While there is little experimental data available using PS for ADHD as of yet, its many cognitive benefits suggest it should prove extremely helpful (Jorisse et al. 2001).

Choline
Choline, a precursor for acetylcholine, is another important supplement for ADHD.  One recent study found that the genetic and structural indicators of poor memory in the brain (called developmental instability) correlated with lower concentrations of creatine-phosphocreatine (Cre) and choline-containing compounds, whereas Cre and N-acetyl-aspartate correlated with good memory.  This finding may be due to differences in frontal lobe energy metabolism (Yeo et al. 2000).

DMAE
Dimethylaminoethanol (DMAE) is naturally present in the brain and found in such "brain foods" as anchovies and sardines.  DMAE accelerates the brain's synthesis of acetylcholine.  As a supplement for ADHD, it has been used effectively to treat such symptoms as shortened attention span, hyperactivity, learning and behaviour problems, reading and speech difficulties, and impaired motor coordination (Dean et al. 1990).

Amino Acids
Adequate protein intake is essential for manufacture of neurotransmitters in the brain from amino acids, which is crucial for reducing ADHD symptoms. Children with ADHD are often deficient in L-glutamine, a precursor for GABA, which is a neurotransmitter that calms the mind and may play a role in hyperactivity. One study suggests that ADHD is caused by a deficiency of glutamate, with prefrontal brain regions being especially affected, while obsessive-compulsive disorder is caused by too much glutamate (Carlsson 2000). Another review found that amino acid supplementation for ADHD is most effective in the short term (2-3 months), but long-term benefits and ideal dosages have yet to be determined (Arnold et al. 2000).

Vitamins
Vitamins may help prevent and treat ADHD by protecting the nervous system from free radical attack and supporting the body in making neurotransmitters. Sociologists Schoenthaler et al. (2000) found that multivitamin supplementation of school-age children (ages 6-12 years old) with behavioral problems such as ADHD help control anti-social behaviors such as swearing, vandalism, assault, and refusal to work. Previous studies by these researchers have shown similar findings among prisoners, ages 13-26. Of all the vitamins, B vitamins are particularly important for fighting ADHD because they assist brain enzymes in using carbohydrates for energy, help synthesize neurotransmitters, such as serotonin, dopamine, and gamma-amino butyric acid (GABA), and form myelin, which shields connections between neurons. A deficiency of B-1 (thiamin) causes nervousness, irritability, and increased sensitivity to noise. B-6 deficiency causes low levels of neurotransmitters such as serotonin, which are found in hyperactive children (Bhagavan et al. 1975). Vitamin C is also important for making neurotransmitters.  Jeff Bradstreet, M.D., a foremost authority in autism and father of an autistic child, recommends sublingual vitamin B12.  Due to poor absorption of B12 in the gut, he has found the sublingual form to work best.  In addition to a good multi-formula, he recommends 1 mg to 5 mg depending on the severity of autism.

Minerals
Select minerals are especially effective in preventing and controlling ADHD.  Zinc is an important co-factor for production of neurotransmitters, prostaglandins, and melatonin and metabolism of dopamine and fatty acids, all of which are involved in ADHD. One study showed that zinc and fatty acids were decreased in children with ADHD (Bekaroglu et al. 1996). A more recent study examined zinc, d-amphetamine, and Efamol (evening primrose or borage oil, rich in gamma-linolenic acid) in subjects with and without ADHD using hair, red cell, and urine measurements to assess zinc levels. Efamol supplementation was beneficial only in those with borderline zinc levels. This suggests that Efamol works by improving zinc deficiency. Zinc deficiency in people with ADHD may also be the reason for poor responses to stimulant therapy (Arnold et al. 2000). Magnesium levels appear to be low in patients with ADHD, and supplementation has reduced hyperactivity (Starobrat-Hermelin et al. 1997). A dosage of 200 milligrams daily has been used in most studies. Finally, iron deficiency has been implicated in ADHD and is a fairly common problem in children.

Herbs
Numerous herbs are shown to help prevent and control ADHD by improving blood flow to the brain and nervous system, reducing stress, and removing toxins from the body.

Hypercoagulation is a disorder in which excess coagulation of the blood leads to hypoxia or low oxygen and death in tissues. In recent studies, hypercoagulation has been linked to immune system function and numerous seemingly unrelated diseases such as cancer, heart disease, and cognitive disorders such as ADHD. To help control hyperocoagulation, an array of hypocoagulant supplements including curcumin (turmeric extract), ginger, and ginkgo should be used (Liao 2000). In ADHD, hypercoagulation is more of a concern in adults than children.

Ginseng (Panax quinquefolius): Ginseng has been the subject of more than 300 studies and is well known for its ability to increase stamina while relieving stress and anxiety.  In fact, it is often used by professional athletes to increase energy and endurance. Its active components, ginsenosides and B vitamins, enhances neuroendocrine function, neurotransmission in the brain and improves the metabolism of protein and carbohydrates.  A study of a combination herbal product containing quinquefolium (200 mg), a panax ginseng extract, and Ginkgo biloba extract (50 mg) was tested for its ability to improve the symptoms of ADHD. Between 31 and 74% of patients taking the medication experienced improvements in various indicators including anxiety, shyness, social problems, hyperactivity, and impulsiveness (Lyon et al. 2001).  The recommended dose of ginseng extract capsules (8% ginsenosides) is 100-200 mg, 3 times per day.

Fish oil, enzymes such as bromelain, and massage have also been shown to lower blood viscosity.

Interestingly, methylphenidate (Ritalin) appears to work like ginkgo and other herbs by increasing regional cerebral blood flow (Kim et al. 2001). Recent structural studies show that in children with ADHD there is decreased blood flow and energy use in the prefrontal cortex and striatum in persons with ADHD. One possible result is a decrease in volume of certain brain areas in people with ADHD. The brain regions responsible for attention, including the anterior corpus callosum, right anterior white matter, and cerebellar areas, are actually smaller in people with ADHD (Paule et al. 2000). Another study indicates there are left hemispheric white matter deficits due to dysmyelination and gray matter deficits in the right hemisphere in ADHD patients (Overmeyer et al. 2001).

Stress-reducing herbs such as passion flower, valerian, or lemon balm are recommended because stress contributes to ADHD (Berdonces 2001). Finally, detoxifying herbs and algae such as spirulina / chlorella have also been suggested for ADHD. Spirulina may help ADHD by removing aluminum, carbon tetrachloride, and other toxins from the body (Torres-Duran et al. 1998; Vadiraja et al. 1998). Sevulla et al. (1995) found an 81% improvement in academic scores when children took 1 gram of spirulina every day for 6 months.

Hormone Imbalances
In adults, certain pro-hormone supplements such as dehydroepiandrosterone (DHEA) may help control or prevent ADHD. ADHD is associated with low blood levels of neurosteroids such as DHEA, its principal precursor pregnenolone, and its principal metabolite dehydroepiandrosterone sulphate (DHEAS). Conversely, higher blood levels of these neurosteroids are associated with fewer symptoms of ADHD (Strous et al. 2001). Pro-hormone supplements are not safe for children. However, hormone-controlling drugs may sometimes help in cases of child ADHD. For example, some research suggests that children ages 2 to 7 with ADHD and learning disabilities have high levels of thyroid hormone and thus thyroid hormone lowering drugs, such as neomercazole, may be effective. Thyroid treatment is effective in the presence of documented thyroid abnormality only (Arnold 2001).

Summary
Conventional treatments for ADHD have included psycho-stimulants such as Ritalin, Dexedrine, and Desoxyn that suppress spontaneous behavior. Recent research has shown that the use of these drugs provides very few if any positive long-term benefits. In addition, serious physical and emotional side effects are seen in children while taking these powerful medications. New non-stimulant drugs with fewer harsh side effects are currently being introduced as a safer alternative. Allergies from genetically altered food and additives may also trigger symptoms of ADHD and hyperactivity. An elimination diet that will pinpoint possible food allergens is recommended. Hormone imbalances such as an overactive thyroid should be checked in both adults and children with ADHD.

Complementary strategies such as behavior modification, physical exercise, and avoidance of environmental toxins can be a safe and effective approach in managing ADHD. Poor nutrition early in life can have long-term effects on brain development and functioning. Many adults and children with ADHD are lacking in vital nutrients. Research has shown that proper supplementation can significantly reduce the severity of their symptoms. Nutritional supplements and appropriate dosages for children should be physician-supervised based on total medical treatment, age, and body size.

  1. Mind-body techniques: Try massage, biofeedback, meditation, and routine setting. Avoid information overload.
  2. Exercise: The American Heart Association recommends 30 minutes of moderate intensity activity on most days of the week and a minimum of 30 minutes of vigorous activity 3-4 days a week. This level of activity is shown to help prevent a wide variety of behavioral and physical disorders in children.
  3. To help control hyperocoagulation, an array of hypocoagulant supplements including curcumin (turmeric extract), ginger, and ginkgo biloba should be used (Liao 2000). In ADHD, hypercoagulation is more of a concern in adults than children.
  4. Environmental health: Avoid pollutants including PCBs and heavy metals (often found in fish). Buy organic foods whenever possible and use air and water filters (Sears.com sells good water distillers).
  5. Diet: Try allergy testing and a Feingold-type elimination diet. Avoid sugar.
  6. Vitamins and minerals:  Life Extension Mix and Children's Formula Life Extension Mix are ideal sources of many vitamins and minerals such as vitamins B and C, zinc, and magnesium, vital in maintaining the health of neurotransmitters.  Follow dosing recommendations on the product label.  Choline helps to restore low levels of acetylcholine in the brain. A suggested dose is 1000-6000 mg daily to boost memory and concentration. However, it is difficult to obtain enough choline in dietary supplements. Adults can obtain high potencies of choline and other nutrients for the brain in a product called Cognitex. Children may have to rely on choline powders with an unpleasant taste. DMAE is a more convenient way for some children to obtain acetylcholine precursors.
  7. Amino acids: Be sure to eat well-balanced meals with complete protein. Adults: glutamine, 1 or more grams daily; and GABA, 1/8 to 1/4 teaspoon daily. Children: glutamine, 250 to 500 mg daily; and GABA, 1/8 teaspoon daily.
  8. DHEA:  Low levels of the neurosteroid DHEA are associated with ADHD. Blood testing is highly recommended first to eliminate the possibility of hormone-related cancers and to establish a baseline for supplementation. DHEA supplementation is not appropriate for children.
  9. Phosphatidylserine (included in Cognitex) is a phospholipid that is vital to neuronal functioning and brain metabolism. Adults: 100 to 400 mg daily for people with neuronal dysfunction. Children: 100 mg daily.
  10. DMAE helps accelerate synthesis of acetylcholine. Adults: Begin at a low dose of 100 mg in the morning and 100 mg in the evening on an empty stomach, gradually building up to 500 mg, twice daily. Some individuals do well remaining at a low dose because side effects such as headaches, muscle tenseness, and insomnia may occur at higher doses. Children: one half the recommendation for adults.
  11. Essential fatty acids: DHA from fish oil is the most important essential fatty acid for the brain. The recommended daily dose of DHA is 1000-2000 mg daily for adults and 500-1000 mg daily for children. For those who cannot afford DHA fish oil, flax oil may work because it usually converts in the body to DHA (and EPA). Flax oil liquid may also be easier for children to take than DHA capsules.
  12. Herbs such as ginkgo and ginseng will improve blood flow to the brain and help remove toxins from the body. Life Extension Herbal Mix enables one to obtain high potencies of brain-boosting herbal extracts along with some acetylcholine precursors. The advantage of Life Extension Herbal Mix is that it comes in a powder form that some children will find palatable. Adults: one tablespoon daily. Children: one teaspoon daily.
  13. Theanine helps calm the nervous system without sedation. Adults: 300-400 mg daily. Children: 100-200 mg daily.

Related links:
Vitamin and Mineral Supplements for People with Autism by Jim Adams (parent of child with autism).  Extra sublingual vitamin B12 as recommended by Dr. Bradstreet -- 1 mg to 5 mg per day depending on the severity of autism.
Vaccine/mercury poison information associated with ADHD and autism http://www.vaccineinfo.net/

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