Gail Szakacs, MD talks about ADHD recovery without drugs by changing the diet, adding supplements and reducing toxic load.
What is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is an increasingly common behavioral disorder characterized by impulsivity, inattentiveness, and hyperactivity. According to Swanson, et al, in Neuropsych Review in 2007, there was a 400% increase in ADHD over the past 20 years and a 7-fold increase in prescription medications for ADHD.
Although it is largely diagnosed in children or adolescents, ADHD also affects adults and the negative impact it can have on learning, school or work performance, and personal relationships is universal.
Are Pharmaceuticals the Right Treatment Choice for ADHD?
Pharmaceuticals may act as a patch and cause improvement, but they often mask signs and symptoms of underlying medical problems and thus are often ineffective. In those with co-morbid psychiatric illnesses, the medication used for ADHD (usually stimulants) can even be dangerous.
Spencer, et al, proposed that many with ADHD have undiagnosed bipolar disorder and stimulant medications used in ADHD may exacerbate that problem. Another study by DuPaul, et al, showed that stimulants are ineffective in 70% of ADHD children with comorbid anxiety.
The potential issues of medication intolerance and development of side effects over time are other reasons to exercise caution in reaching to medication first when treating someone with ADHD.
What Causes ADHD?
Accumulating evidence suggests the etiology of ADHD is multi-factorial and therefore it may not always respond to stimulant medication. Potential causes of ADHD include, but are not limited to:
- Nutritional deficiencies and imbalances
- Impaired detoxification
- Allergies and immune dysfunction
- Gastrointestinal disorders
- Mitochondrial dysfunction
Treating the Root Cause Rather than the Symptoms
The expanding nature of the ADHD population, scope of potential contributing factors, and increasing reliance on often ineffective medication signals the demand for a more individualized and comprehensive approach for the ADHD population.
Underlying medical issues often trigger internal dysregulation in one or more organ systems that manifests as changes in behavior and cognition. Finding and treating these underlying issues often improves behavior and cognition, which promotes more effective learning and greater success in many areas of life.
This article highlights aspects of the integrative approach for those with ADHD, concentrating on studies involving diet/nutrition and toxins as underlying contributing factors. Everything presented here is only meant for information and education, not direct diagnostic or treatment recommendations.
Why Diet and Nutrition Matter
Improvement of Behavioral and Cognitive Changes
Subtle dietary changes can promote significant behavioral and cognitive changes. The impact of early poor nutrition depends on timing in relation to critical brain development, but if poor nutrition continues or develops later, it can have profound negative effects.
Liu, et al, showed a 15.3 point IQ deficit in a prospective, longitudinal study of malnourished children at age 3. As far back as 1922, there were published reports of improvement in hyperactivity and learning issues with an elimination diet, a diet that eliminates certain foods like wheat, soy or dairy.
Dr. Ben Feingold’s work in the 1970’s highlighted the relationship between hyperactivity and artificial food colorings, flavorings, preservatives, and salicylates. Many other researchers have found similar results.
Removal of Dietary Peptides
The relationship between dietary peptides (like gluten from wheat and casein from dairy) and neurologic function and behavior is well documented as well. Horvath, et al, and others, have shown that increased intestinal permeability can allow poorly digested peptides (as well as toxins, allergens, etc.) into the bloodstream where they can trigger inflammation, immune dysregulation, and affect neurologic and psychologic function.
In 2006, Niederhofer showed that ADHD-like symptomatology is often present among untreated celiac disease (lifelong gluten intolerance) patients and a gluten-free diet can improve those symptoms.
Addition of Missing Nutrients
In terms of general nutrition, it is clear that vitamins and minerals are essential to cognitive function. Various researchers have found low levels of vitamins and minerals in children with a range of neuro-developmental disorders, as well as cognitive, behavioral, and academic improvement in those receiving specific supplementation.
For instance, in one study by Schoenthaler, et al, 50% of U.S. daily RDA (daily vitamin – mineral supplement) for four months (versus placebo) lowered institutional violence and antisocial behavior by nearly 50%.
Medical research indicates that vitamin and mineral deficiencies correlate with symptoms of ADHD and supplementation can improve symptoms. The information below on supplements and how they can affect behavior and cognition illustrates the importance of finding and treating nutritional imbalances in those with ADHD.
Note: All supplementation should be done under the guidance of a qualified medical professional.
Children with moderately severe iron-deficiency anemia as infants had lower scores on tests of mental and motor functioning at school entry. Low iron associated with changes in serotonin, noradrenaline, and dopamine levels; iron supplementation has short and long-term benefits in behavior and psychomotor-development.
In a 12-week study, 23 children with ADHD, ages 5 to 8, with serum ferritin (iron stores) less than 30, 18 were given iron sulfate, and five were given a placebo. Those given iron had decreased ADHD rating scales.
In an eight-week study, 73 girls with low serum ferritin were randomly assigned ferrous sulfate or placebo. The iron group performed better on verbal learning and memory tests.
Note: Iron supplementation should be done with caution as it could further exacerbate mitochondrial dysfunction — seek the advice of a medical professional.
Essential Fatty Acids
Essential fatty acids are the “good fats” such as omega-3s found in cod liver oil and flaxseed oil. One study with 44 hyperactive children and 45 matched controls showed that various essential fatty acid levels were significantly lower in the hyperactive group.
A randomized, double-blind, placebo-controlled six-week pilot trial showed that 13 children with autistic disorders and severe tantrums, aggression or self-injurious behavior had improved behavior after supplementation with omega-3 fatty acids. Another study showed that pure EPA is effective for depression and schizophrenia, while a combination of EPA and DHA is better for ADHD.
Pycnogenol is a natural plant extract that has powerful antioxidant and anti-inflammatory effects. This supplement has been shown to:
- Improve attention
- Help regenerate vitamins C and E
- Lower inflammation
- Provide immune support
- Treat allergies
- Potentially improve EEG, handwriting, and academic success
In a study of 116 children with ADHD, ages 9 to 12 years old, 95% had a magnesium deficiency.
Acetyl-L-carnitine has been shown to decrease hyperactivity in fragile X patients.
Carnosine has been shown to be neuroprotective.
Phosphatidylserine is important for synaptic membrane and neurotransmitter function. In a four-month trial study of 21 patients with ADHD, ages 4 to 19, approximately 90% of those with attention and learning issues were improved after supplementing with phosphatidylserine. (Ryer, et al. Lancet (letter), Benefits of PS against attention deficit in a preliminary study).
In a four-week study with 36 ADHD patients, ages 3 to 17, 44% saw social improvements and 74% saw improvements in Conners’ ADHD index and hyperactive/impulsive behaviors after supplementation with a combination of American ginseng and Gingko biloba.
Why Harmful Environmental Exposures Should be Minimized
Toxic load due to chemicals, toxic metals, and allergens can cause oxidative stress, increased burden on the immune system, and behavioral and cognitive changes. Infections, trauma, injury, stress, and poor diet can all further increase oxidative stress.
Many chemicals and metals are recognized causes of neurodevelopmental disorders and subclinical brain dysfunction. Exposure during early fetal development can trigger brain injury at doses much lower than those affecting adult brain function.
The information below from various studies highlights the importance of exploring causes of oxidative stress as contributing factors in ADHD.
- Children exposed to higher chlorpyrifos (insecticide) levels were more likely to experience Psychomotor Development Index and Mental Development Index Delays, attention problems, ADHD, and pervasive developmental disorder problems at 3 years of age.
- Prenatal environmental tobacco smoke is a risk factor for ADHD.
- Dose-response relationship between childhood lead exposure and ADHD.
- In a Texas study, on average, for every 1,000 pounds of environmentally released mercury, there was a 43% increase in the rate of special education services and a 61% increase in the rate of autism.
- In a case report of a 4-1/2 year-old boy with ADHD and autism and increased blood lead level who was treated with succimer (a medicine used to remove lead and other metals), his repetitive behavior and hyperactivity stopped. After succimer was stopped, he regressed.
- A study showed that environmental lead exposure in children who have blood levels of lead greater than 7.5 µg/dl have higher levels of intellectual deficits.
- Pollen exposure is a cause of regression in neurobehavioral function in children with autism and ADHD.
- Three large German studies suggest a strong and independent association between atopic dermatitis (eczema) and ADHD. One of the studies reported a 2.67-fold increased likelihood of ADHD in those with atopic dermatitis and parent-reported sleep problems (article by Bruce Jancin in Internal Medicine News; studies from JAMA and Pediatric Allergy Immunology journals cited in this article).
In looking at possible underlying medical problems as contributing factors in ADHD, the integrative approach to those with ADHD offers an individualized and comprehensive alternative approach that can either make medication unnecessary or reduce it to a temporary and adjunctive intervention.
As the medical community continues to learn about the etiologies of ADHD, the information presented here provides more pathways for a patient to explore with his or her physician and may ultimately lead to more natural treatment options for those with ADHD.
Still Looking for Answers?
Sources & References
Amminger, G.P., et al. Omega-3 fatty acids supplementation in children with autism: a double-blind randomized, placebo-controlled pilot study. Biol Psychiatry. Feb 2007;61(4):551-3.
Arnold, L.E., et al. Does hair zinc predict amphetamine improvement of ADD/hyperactivity? Int J Neurosci. 1990;50:103-107.
Bekaroglu, M., et al. Relationships between serum free fatty acids and zinc, and attention deficit hyperactivity disorder: a research note. J Child Psychol Psychiatry. 1996;37:225-227.
Boris, M.J., et al. Pollen Exposure as a Cause for the Deterioration of Neurobehavioral Function in Children with Autism and Attention Deficit Hyperactive Disorder. J of Nutritional and Environmental Medicine. Mar 2004;14(1):47 – 54.
Braun, J.M., et al. Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. children. Environ Health Project. Dec 2006;114(12):1904 – 1909.
Bruner A.B., et al. Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls. Lancet. Oct 1996;348(9033):992-6.
Calvani, M., et al. [L-acetylcarnitine treatment on fragile X patients hyperactive behaviour]. Rev Neurol. 2001;33 Suppl 1:S65-S70.
Coleman, M., et al. A preliminary study of the effect of pyridoxine administration in a subgroup of hyperkinetic children: a double-blind crossover comparison with methylphenidate. Biol Psychiatry. 1979;14:741-751.
DuPaul, G.J., et al. Interventions for students with Attention – Deficit/Hyperactivity Disorder: One size does not fit all. School Psychology Review. Jan 199726(3):369-381.
Eppright, T.D., et al. Attention deficit hyperactivity disorder, infantile autism, and elevated blood-lead: a possible relationship. Mo Med. 1996;93(3):136-8).
Greenblatt, J. Nutritional supplements in ADHD. J Am Acad Child Adolesc Psychiatry;38(10):1209-1210
Horvath, K., et al. Autism and gastrointestinal symptoms. Curr Gastroenterol Rep. 2002 Jun;4(3):251-8.
Konofal E, et al. Effects of iron supplementation on attention deficit hyperactivity disorder in children. Pediatr Neurol. Jan 2008;38(1):20-6.
Kozielec, T., et al. Assessment of magnesium levels in children with attention deficit hyperactivity disorder (ADHD). Magnes Res. 1997;10(2):143-8.
Lanphear, B.P., et al. Low-level environmental lead exposure and children’s intellectual function: an international pooled analysis. Environ Health Perspect. 2005;113(7).
Liu, F.J., et al. Pycnogenol enhances immune and haemopoietic functions in senescence-accelerated mice. Cell Mol Life Sci. 1998;54(10):1168-1172.
Liu, F. Pycnogenol protects vascular endothelial cells from beta-amyloid-induced injury. Biol Pharm Bull. 2000;23(6):735-737).
Liu, J., et al. Malnutrition at Age 3 Years and Lower Cognitive Ability at Age 11 Years. Arch Pediatr Adolesc Med. 2003 Jun; 157(6): 593–600.
Lozoff, B., et al. Long-term developmental outcome of infants with iron deficiency. N Engl J Med. 1991 Sep 5;325(10):687-94.
Lyon, M.R., et al. Effect of the herbal extract combination Panax quinquefolium and Ginkgo biloba on attention-deficit hyperactivity disorder: a pilot study. J Psychiatry Neurosci. 2001;26(3):221-228.
Mitchell, E.A., et al. Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clin Pediatr (Phila). 1987;26:406-411.
Niederhofer, H., et al. A preliminary investigation of ADHD symptoms in persons with celiac disease. J Atten Disorder. 2006 Nov;10(2):200-4.
Palmer, et al. Environmental mercury release, special education rates, and autism disorder: an ecological study of Texas. Health Place. 2006(12):203-209.
Parks, Y.A., et al. Iron deficiency and the brain. Acta Paediatr Scand Suppl. 1989;361:71-7.
Rauh, V.A., et al. Impact of prenatal chlorpyrifos exposure on neurodevelopment in the first 3 years of life among inner-city children. Pediatrics. 2006;118;e1845-1859.
Richardson, A.J., et al. Omega-3 fatty acids in ADHD and related neurodevelopmental disorders. Int Rev Psychiatry. 2006;18(2):155-172).
Rohdewald, P. A review of the French maritime pine bark extract (Pycnogenol), a herbal medication with a diverse clinical pharmacology. Int J Clin Pharmacol Ther. 2002;40(4):158-168.
Schmitt, J., et al. Atopic eczema and attention-deficit/hyperactivity disorder in a population-based sample of children and adolescents. JAMA. 2009 Feb 18;301(7):724-6.
Schoenthaler, S.J., et al. The effect of vitamin-mineral supplementation on juvenile delinquency among American schoolchildren: a randomized, double-blind placebo-controlled trial. J Altern Complement Med. 2000 Feb;6(1):7-17.
Shannon, W.R. Neuropathic Manifestations in Infants and Children as a Result of Anaphylactic Reaction to Foods Contained in Their Dietary. American Journal of Diseases of Children. Jul 1922(24): 89-94.
Swanson, J., et al. Etiologic Subtypes of Attention-Deficit/Hyperactivity Disorder: Brain Imaging, Molecular Genetic and Environmental Factors and the Dopamine Hypothesis. Neuropsychology Review 17, 39-59 (2007).
Trombley, P.Q., et al. Interactions between carnosine and zinc and copper: implications for neuromodulation and neuroprotection. Biochemistry (Moscow). 2000;65(7):807-16).