The Bio-Chemical side of ADD/ADHD

(Brain-Based Therapy is the most important treatment for ADD/ADHD though it is never exclusive in our office.  See that section as well!!!)

A.D.D. has been described as a "pervasive or recurrent inattention, impulsiveness, and learning disability based on chronological age, mental, and emotional maturity with/without hyperactivity." A.D.D. is a condition/symptom and not a disease.

Bio-Chemical Causative and/or Exacerbating factors

1. DIETARY FACTORS OF RAPID ONSET: Food additives, impaired simple carbohydrate (glucose) metabolism, and food allergies/sensitivities are common especially if they seem to be have "good days" and "bad days."
2. SENSORY INPUT IMPAIRMENT: Chronic fluid retention in the middle ear - children with moderate to severe hearing loss tend to have impaired speech and language development, lowered general intelligence scores and learning difficulties. Visual abilities such as integration, tracking, etc. play a significant role.
3. NUTRIENT DEFICIENCIES: Almost any nutrient deficiency can impair brain function. Iron deficiency is among the most common nutrient deficiency in American children and is associated with marked reduction in attentiveness, less complex or purposeful, narrower attention span, decreased persistence and decreased voluntary activity. Correction of even subtle nutritional variables exerts a substantial influence on learning and behavior. I find absolute or relative zinc insufficiency in the majority.
4. HEAVY METAL EXPOSURE: There is a strong and well documented relationship between childhood learning disabilities including hyperactivity and body stores of heavy metals, particularly lead.

A study by Thiel, Ph.D. (ANMA Monitor 1997:1(9): 5-8) of adults and children with A.D.D. showed 52% needed calcium, 48% needed GABA, B6, and/or flax oil, 45% needed thyroid nutritional support, 29% needed infection support, 10% needed pancreatic-blood sugar management with GTF and B vitamins, and 16% needed specific vitamin or minerals. He found over 90% were intolerant to dairy (42%), colorings/preservatives (23%), simple carbohydrates and wheat (19% each) and/or caffeine (10%).

Initial Diagnostic Considerations

Food Sensitivities - There are many ways to try to assess food hypersensitivity. Each has limitations. Allergy skin tests are rapid, inexpensive, and considered by traditional allergist to be accurate. They can be helpful when positive but do not include non-IgE mediated immune reactions to foods or other ingested agents. Blood tests include methods to detect allergies caused by IgE or IgG antibodies. Drawing blood is required, they can be expensive, but have the advantage of having a wider array of foods available than skin tests. Tests using IgG may help identify foods that cause delayed reactions but may only indicate recent or recurrent intake or poor digestion rather than allergic or hypersensitivity reactions. Other immunologic tests include the ELISA/ACT and MRT that reportedly reveals other type of immune reactions. If foods/items reactive on an ELISA/ACT are avoided as outlined by the laboratory, improvement in those conditions related to immune reactions have been in scientific studies but not always observed in my practice. None of the above procedures identifies foods/items that cause metabolic reactions without an immune basis. Muscle tests or other Applied Kinesiology techniques can help but are dependent on the skill of the tester and are considered controversial by traditional medical doctors and entirely dependent on the bias of the tester. Electromagnetic and resistance type tests use a similar basis for finding intolerances but also depend on the skill of the tester, the device being used, and are controversial. A diet diary with food avoidance of "high-risk" foods or by use of defined rotational diets often provides the most convincing information and is without any financial expense.

Sensory Input Impairment - audiometry and tympanometry are simple, inexpensive, and readily available tests. More sophistic testing with neural mapping of hearing and visual input may also be worthwhile. Functional vision problems should be evaluated by a Developmental Optometrist since vision is more than simply having 20/20 eyesight. It is a complex process involving over 20 visual abilities and more than 65% of all the pathways to the brain. Nearly 80% of what a child perceives, comprehends and remembers depends on the efficiency of the visual system.

Nutrient Deficiency - can be detected by a few symptoms such as peculiar food intake habits, clumsiness or poor eye hand coordination, and a few physical findings suggestive of mineral imbalances. Specialized but commercially available laboratory tests of the blood, urine, and hair can also give insight into the nutritional and metabolic status of the individual. Unfortunately most medical doctors are not as familiar with these tests. Bring in all old lab reports, even if "normal," since a standard chemistry panel may suggest nutrient imbalances.

Heavy metal evaluation - Hair analyses are a simple and inexpensive screening tool for heavy metals. When collected properly, hair samples give a reliable indication of heavy metal burdens. The hair analysis has been mis-used in the past and has a bad reputation. For toxic elements, however, it is an inexpensive, accurate and painless test. A more sensitive test uses a 24-hour urine collection after giving a medication (DMSA) that chelates out heavy metals. This is a called a urinary provocation challenge. Blood tests may help, too. We also use the urine to determine the presence of ionic metals in the urine (Urine IMT). The color of the reaction gives a clue as to the type of metals being excreted.

Our Bio-Chemical Approach to Management:

With any type of ongoing chronic condition, five considerations must be addressed.

1. PROVIDE SPECIFIC NUTRIENTS that the individual requires to achieve and maintain optimal health
2. DETOXIFY/DE-INFECT something that the body has not been successful at getting rid of such as lead, mercury, yeasts, parasites, etc.
3. AVOIDANCE those things that make you worse like sugar, food additives, food to which you may be allergic.
4. REPAIR ANY INTERFERING FIELDS that are preventing the body from balancing itself. This can be from the scars due to an infection, surgery or trauma, or an emotional event. For more information, see the webpage on Brain-Based Therapy.
5. UNBLOCK THE SUBCONSCIOUS/EMOTIONS that sabotage the progressive recovery. 

Food Recommendations - for all children limiting simple processed carbohydrates (sugar, candies, sweets, fruit juices, etc.), margarine, hydrogenated fats, tans fats, fried foods, and aspartame is required without exception. Specific foods based on tests or observations at home or school play a critical role in nearly every case successfully managed. Gluten and milk proteins are common problems. Make sure every meal contains adequate protein and nutrients. For most of the children that have A.D.D. or A.D.H.D. following a strict diet is mandatory. In fact, the success rate is so low in patients that do not comply with dietary recommendations; we feel that you are simply wasting your time and our time if you don't follow the specific recommendations.

Nutritional Supplementation - A USDA report on the vitamin and mineral status of Americans eating a standard Western diet showed marked and widespread nutrient deficits without obvious signs of malnourishment or disease. Based on this data and my own nutritional evaluations of children with A.D.D., autism, and other learning difficulties, specific and individualized supplementation is nearly always required and helpful. Remember what is good for one child will be detrimental for another.

The following have been suggested in certain circumstances. While a try-and-see approach may be tempting, we recommend a precise and predictable approach to using supplements. After all, too much of one thing actually may create a greater imbalance in the end:

• B Complex (specifically niacin and B6) has been reported to be beneficial, especially if serotonin is low (often with ADHD).
• Essential fatty acids may be deficient and supplementation may be beneficial according to a 1981 study in Medical Hypothesis. Giving the right essential fat can be a homerun. Usually, if the wrong type of fat is used a noticeable deterioration in behavior occurs in a short period of time. It has been reported that EPA (one of the omega-3) oils tends to make people more active while DHA (another omega-3) tends toward a calming effect.
• Magnesium is commonly deficient in children with A.D.D. or hyperactive children. Magnesium has a quieting effect on the central nervous system and is a component of over 300 enzymes, including sugar and energy metabolism. Deficiency reportedly causes mast (allergy) cells to release more histamine. Magnesium may help hyperactivity and helps utilize vitamins B, C and E.
• Calcium deficiency can cause hyperactivity, nervous stomach, cramps, and tingling in the arms and legs. It competes with lead.
• Zinc/Copper/Iron/Manganese imbalances are very common and correction is essential and often dramatically helpful.
• Glutamine has been shown to improve intelligence, speed ulcer healing, support the gastrointestinal lining, give a "lift" from fatigue, control alcohol and sugar craving, and help schizophrenia. In one study by Dr. Roger Williams, 75% of hyperactive and A.D.D. children had low plasma levels of glutamine. Glutamine also helps with acid-base balance and detoxication.
• Glycine is an inhibitory neurotransmitter with a calming effect and may help break a sugar addiction and in aggressive behavior.
• GABA is also an inhibitory neurotransmitter that slows anxiety-related messages within the brain. Valium, Gabapentin, etc. are medications that act on this pathway so you can imagine the type of response you can expect when using supplements that provide either more GABA or stimulate the GABA receptor.
• Taurine is often important in controlling hyperactive or hyperkinetic movements and is used for epilepsy and anxiety. It is usually associated with zinc or magnesium.
• Serotonin is often low in children with hyperactivity along with vitamin B6 and tyrosine. Supplementation with 5-HTP has been reported to help with aggression when combined with vitamin B6. Please see my webpage on Neurotransmitter Repletion for more information.
• Tyrosine is often helpful for depression, in resisting stress, building up adrenaline stores, and in increasing mental focus (voltage effect of catecholamines). Theoretically excessive intake could contribute to hyperactivity so caution is required.
• As of December 2003 we have seen some encouraging results using homeopathic remedies. Homeopathy is not nutrition and the science behind homeopathic agents can be difficult to understand. For this reason there is much controversy, especially among traditional physicians about using homeopathy.
• Since the thyroid hormone, liothyronine (also known as T3 or sold as a prescription medication under the trade name CytomelÒ) has been shown to be a neurotransmitter, this can be a very useful component in selected circumstances. The web page on thyroid might be helpful to understand more about thyroid hormones and replacement therapy options.

* One of the advantages of using simple nutrients like vitamins, minerals, essential fats, amino acids, etc. is that unlike herbs, there is little interference with medications.

Detoxication - of specific heavy metals or when there are non-specific features of organic toxin exposure can provide dramatic improvement but must be done slowly since detoxication itself can provoke a variety of symptoms. In some children an overgrowth of yeast is a contributor and with reduction in yeast levels, there is a significant improvement. We have a number of oral options for increasing the excretion of heavy metals including arsenic, mercury, cadmium and lead.

Behavioral Interventions - for these I refer out to their respective experts