ecoyear

I've been thinking of doing a post for a while, trying to organize the diverse and abundant information I have been gathering on ADHD.

This is a bit of an opinion piece. This is my emerging understanding of this problem based on reading the functional medicine literature. I am not so interested on suppressing symptoms by using medication for years on end. I am interested in finding underlying causes, the simpler the better, in an effort to return the person to a state of health.

To those who say ADHD is normal, just boys being boys, etc... I say - living with it in one's family quickly reveals this is simply not the case. It's not just that kids with ADHD need to move around a lot. There's something about emotional self-regulation, and being able to plan ahead to get what one wants, that's simply missing in these kids, and this makes life for them and those responsible for them, painful at times.

So I believe, something needs to be done. What to do will depend on the individual.

At this point in my retraining as a functional medicine physician, I understand ADHD (and autism, and autism spectrum disorders) as being the end result of a variety of possible impacts on the child's development. These disorders appear to involve inflammation, which means that the immune system has something to do with it. They also involve genetics, as revealed by studies of family members and twins. They very much involve the environment, as revealed simply by the fact that their incidence is rising. This is clearest for autism, simply because autistic children are very hard to overlook, or fail to diagnose. It is more murky for other neurological issues.

The other thing I am reading about is that they involve problems with energy utilization within the brain. There are abnormalities on scans of blood flow to various parts of the brain. This does not tell us what causes these blood flow issues. There are also abnormalities in the way some parts of the brain work at the cellular level. Mitochondria seem to be affected. Neurotransmitters are most definitely affected.

These disorders also sometimes involve xenobiotics. That's a fancy word that means "chemicals that aren't normally in the body" - they include chemicals invented by humans, such as pesticides, and poisons from the environment such as lead and mercury. These tend to accumulate in fatty tissues within the body, and the brain is made up of fat.

ADHD involves problems with essential fatty acids. These are components of food that are assimilated by the body and used up to build cell membranes and other crucial working cell components.

So, treatments that reverse ADHD have involved a variety of approaches. Most work a little on their own, and much better in combination with other treatments. Here's a long list, along with a little comment as to how they fit into the whole picture.

Diet plays a huge role. Some chemicals, such as artificial coloring, causes hyperactivity in "normal" children, and certainly make children with ADHD worse. Elimination diets improve symptoms in a large majority of the kids who can actually stay on the diet (and a majority of kids do stay on the diet). Beliefs on various diets have come and gone. This latest blockbuster is from a study published in 2011.

If ADHD involves significant inflammation, then it stands to reason that interventions that reduce inflammation would also reduce symptoms. Typically, there are 5 major steps to reducing inflammation:

1. The first, is a return to a caveman diet: nuts, berries, fruits, vegetables, seeds and lean sources of protein. Watch out for the fish (mercury), and the animal protein should come from grass-fed, free-ranging animals. Lean is supposed to be better because pesticides accumulate even in organic animals, given their presence in the air we breathe.

2. The vitamin D status should be checked and corrected.

3. Essential fatty acids, usually in the form of high quality fish oil, are likely to work. One study reports giving more EPA than DHA, another reports giving more DHA, less EPA. It may simply depend on the child. A blood test for these could help guide treatment. This is rarely done in the research.

4. Multivitamins are a good idea because the child's need for antioxidants, B vitamins, zinc, magnesium, iron, and vitamins C and E is likely to be high. These vitamins and minerals are affected by stress levels, which tend to rise when someone's behavior is constantly a source of grief. Also, the antioxidants especially help protect the fatty acid supplements from harm within the body.

5. Exercise is an important component of treatment for ADHD. I think this is because exercise reduces stress. It also helps the body make new mitochondria, which are supposed to be affected. Exercise affects the brain, allowing it to make new neurons, and connections between neurons.

6. Probiotics may be a good idea (I haven't seen published research here) because gut dysbiosis (the wrong bacteria) is an important component of inflammation. Getting the bacteria right could help heal the gut, which in turn would decrease potential for mischief from digestive issues. I know this is vague, but it appears that "bad" bacteria are making chemicals from food in our intestines, that then enter the bloodstream and affect behavior. Weird, but apparently true...

7. Some researchers have seen success with medium doses of two amino acid precursors: 5-HTP and tyrosine. A majority of children begin to do better just days after starting on these supplements. Some of the children who don't respond at first, do finally respond when the doses of supplements are adjusted according to results of urine tests for amino acids.

8. Direct stress reduction, such as the use of the HeartMath monitor, have also had some success.

Conclusion:

Suppose you have a child aged 3-18, either diagnosed with ADHD, or who seems to you scattered, overly active or absent-minded in the extreme - what can you do that seems reasonable, that doesn't involve expensive testing and specialist visits, and might avoid the use of stimulant and other medications?

A. I would go ahead and do the above diet. It is a very healthy diet that eliminates GMOs and processed foods with weird ingredients. It is strange at first, but grows on you and seems the only reasonable way to eat. Things are changing quickly - food allergies are up dramatically, and some physicians are claiming that 40% of us are gluten intolerant.

B. I would add fish oil, about 1g daily. I am partial to Nordic Naturals, because they seem to pay attention to harvesting fish sustainably, and to the quality of the product: no mercury, no rancid oils. They have it tested by an independent laboratory. There are other brands that can be recommended by someone who is knowledgeable concerning supplements.

C. If you use fish oils, then you have to use a good quality multivitamin. Here, too, I would get advice from someone who uses and understands supplements. The brands at the store unfortunately don't usually have enough B vitamins, or even C vitamins. Or they lack vitamin A, or don't have much vitamin D. Or they have the wrong kind of folate or vitamin E. It's hard to know what you need exactly, but these are pretty basic.

D. Instead of probiotics, you can use fermented foods, the problem is which one. If milk turns out to be okay, you could use kefir, but otherwise, you have to hope you child likes sauerkraut or kombucha.

E. Exercise would round out this intervention as a general recommendation. Daily, a 30 minute walk or bike ride, or other activity, and yoga would be awesome if you can get it to happen.

I'm imagining that if you did all this, you would see a clear improvement. It still might not be enough to get off all medication, in which case you would want to consult with someone well-versed in functional medicine, or a really good homeopath. It becomes detective work, and sometimes breakthroughs happen by chance.