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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.
- Mind-body techniques: Try massage,
biofeedback, meditation, and routine setting. Avoid information
overload.
- 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.
- 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.
- 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).
- Diet: Try allergy testing and a
Feingold-type elimination
diet. Avoid sugar.
- 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.
- 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.
-
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.
- 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.
-
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.
- 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.
- 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.
-
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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