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ADHD

Attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed psychiatric disorder in children. Symptoms present as inattention and impulsivity combined with or without hyperactivity. Worldwide ADHD rates are increasing with current estimates around 10% of all children. Approximately 50% of all childhood cases persist through adolescence and into adulthood. Untreated, ADHD leads to a variety of problems such as poor academic performance, poor socialization, increased addiction rates, and increased traffic accidents(a leading cause of death). Our approach to treatment of ADHD is built on natural and alternative therapies to support immune reactions, brainwave irregularities, and genetics specific for ADHD.

Assessment of ADHD with Brain Mapping (QEEG)

Brain mapping or QEEG is one of the fastest and clearest ways to determine the presence or variants of ADHD. Brain mapping produces pictures of electric brainwave patterns, commonly known as Delta, Theta, Alpha, and Beta brainwaves. A patient’s brain waves are compared to a normal sample to see how he or she compares to others without symptoms of ADHD. Children and adults whose brain waves are not symmetrical or “run” too fast or slow may present with a variety of symptoms mimicking ADHD. Brain mapping is also used to evaluate for depression, anxiety, developmental delay, and brain inflammation or injury. Children often present with mixed symptoms of inattention and anxiety in the case of suspected or diagnosed ADHD. Anxiety is rarely apparent to parents or teachers nor is it reported by the child. Once we appreciate the irregular patterns and their association with the symptoms of ADHD, treatments to normalize the imbalanced brainwaves can lead to reduced symptoms.

Biofeedback and Neuromodulation for treatment of ADHD

Neurofeedback therapy is the leading non-prescription treatment to reduce the symptoms of ADHD. It does this by improving connectivity between all the areas of the brain, improving blood flow to the prefrontal cortex, balancing brain wave patterns, and improving auditory processing. Results of Neurofeedback therapy have been verified with fMRI studies indicating these modalities of brain biofeedback actually improve neural networks and connectivity. Numerous studies have indicated Neurofeedback to be a promising alternative or additional treatment without reported adverse effects.  Once specific brain patterns of ADHD are discovered, individualized treatment goals are programmed to provide feedback of the best brain patterns to train, reducing the symptoms of poor attention and learning. Neurofeedback training involves stimulating visual and auditory feedback, aimed at normalizing brain activity. Controlled trials have assessed the efficacy of neurofeedback training in children with ADHD compared to psychostimulants with similar results. More importantly, follow up studies provide evidence for long-term or sustained benefits. Compared to psychostimulants, neurofeedback offers a safe, effective, and lasting alternative. A comprehensive review of Neurofeedback studies confirm Neurofeedback not only is a suitable intervention for those diagnosed with ADHD but also may be the preferred choice of interventions for some individuals. 

ADHD Lifestyle and Diet Recommendations

In addition to training the brain to reduce ADHD symptoms, changes at home can also contribute to a reduction in symptoms, more particularly hyperactivity. It is well known that our food choices play a role in our long-term physical health. It is less recognized that nutrition can also have profound effects on our mental health, attention, and behavior. The following guidelines can be helpful to encourage changes in the diet of children with ADHD. Testing for food triggers, food additives, and environmental toxins is highly recommended. Without precise laboratory confirmation to rule these immune responses out, we recommend the concerns presented here valid for each child. 

Go organic– Several studies report a correlation between pesticide exposure in children and Attention Deficit and Hyperactivity Disorder. In previous studies children diagnosed with ADHD had the highest urinary levels of organophosphate pesticides. Approximately 40 organophosphate pesticides are registered for use in food production with the U.S. Environmental Protection Agency. Most of our exposure to these pesticides comes through our food and water with the majority of detectable concentrations found in many of our fruits and vegetables. Utilizing organic produce as much as possible, but particularly for the “dirty dozen” can decrease exposure by up to 80%. Visit the Environmental Working Group’s website, www.ewg.org for the current annual list of the worst offending fruits and vegetables.

Elevated pesticides in children are likely a result of increased exposure to non-organic foods or due to genetic mutations or SNP’s in detox pathways. With less than optimal SNP’s a child will struggle to break down and eliminate(detox) pesticides found in food. Impaired genes such as Paraoxonase 1(PON1)  have impaired ability to metabolize organophosphate pesticides.This effect is even more pronounced in babies and young children since PON1 activity is innately lower in infants and children. This reduced ability to clear these pesticides can result in increased oxidative stress and a higher risk of organophosphate toxicity and possible neurodevelopmental disorders. The natural supplements Quercetin and Curcumin can upregulate this pathway reducing toxic risk and load. 

Other genes such as EPHX I, BCHE, GSTM1, and GSTP1 regulate the ability to detoxify many toxins including pesticides. Reduced function in these genes lower our ability to clear pesticides and can result in increased sensitivity to organophosphate pesticides and increased oxidative stress. This results in a higher risk of organophosphate toxicity. Sulforaphane, the active ingredient in 3 day old broccoli sprouts along with N-acetyl-cysteine (NAC) will support the detox pathways to eliminate the burden of pesticides in the body.

Avoid artificial food colorings and the preservative sodium benzoate– A landmark study conducted in the UK on three hundred 3-year-old and 8/9-year-old children in the general population found artificial colors or sodium benzoate preservative (or both) in the diet resulted in increased hyperactivity (McCann et al., 2007). This study led the European Union to ask manufacturers to voluntarily remove several artificial food colors from foods and beverages or to add a warning label that the artificial food color “may have an adverse effect on activity and attention in children” (Arnold et al., 2012). Conversely, in the US, the FDA reviewed the study and determined that the relationship between consumption of color additives and hyperactivity in children could not be definitively established (Arnold et al., 2012). The effect of food additives in children is also aggravated from specific variations in the HNMT gene, which helps break down histamine in the body. Children with variations in this gene had stronger behavioral reactions to artificial food colors than children without this variation (Stevenson et al., 2010). Food colorings and preservatives can cause excessive release of histamine and with gene variations the inability to break down histamine in children. Thus, food additives spur the release of histamine that in turn affect the brain and behavior of children. Food additive testing is available to confirm immune responses that are linked to increase immune responses from excessive histamine.

Avoid food triggers– Sugar, wheat, and milk are among the most common dietary food triggers for ADHD symptoms. Multiple connections have been made between sugar, dairy, and gluten consumption with hyperactivity, and the risk for ADHD. In a study of 400 school-age children who ate sweets (ice cream, refined grains, sweet desserts, sugar, and soft drinks) had almost four times greater odds of having ADHD compared to those who ate sweets less often (Azadbakht & Esmaillzadeh, 2012). In a similar study 1,800 adolescents consuming a “Western” diet (higher intakes of total fat, saturated fat, refined sugars, and sodium) more than doubled the odds of an ADHD diagnosis (Howard et al., 2011). In another study on 986 children found a high intake of sweetened desserts (ice cream, cake, soda) was significantly associated with worse inattention, hyperactivity-impulsivity, aggression, delinquency, and externalizing problems. In contrast, a high-protein diet was associated with better scores on these measures. A high level of sweetened dessert consumption was also associated with lower scores on tests of listening, thinking, reading, writing, spelling, and math (Park et al., 2012).

Of great concern are proteins found in milk(casein) and gluten(gliadin) that severely aggravate ADHD symptoms by binding to opiate receptors in the brain. Some struggle from a build up of these reactive proteins because of the inactive dipeptidyl peptidase IV, a zinc-dependent enzyme that breaks down both casein and gluten.

QEEG brain mapping to evaluate brain wave patterns also provides evidence of “trigger” foods increasing beta activity in the frontal temporal regions of the brain. Excessive brain waves in this region can lead to anxiety and have a stimulating effect (Uhlig et al., 1997). 

Malnutrition can also negatively affect behavior and cognition while deficiencies of certain nutrients can have detrimental effects on children as well. Fortunately, eliminating offending substances can rapidly improve physical and behavioral symptoms while improving the quality of absorption of vital nutrients.

Non-stimulant prescriptions for ADHD

Methylphenidate and other stimulants are the most frequently prescribed medications for ADHD. Stimulants are known to increase the availability of excitatory neurotransmitters, principally the catecholamines dopamine and norepinephrine. Higher levels of dopamine and norepinephrine improve attention and focus in both children and adults with ADHD. The following non-stimulant medications are newer options that improve activity of attention and impulsivity without the stimulant effects. 

Atomoxetine

Atomoxetine (Strattera) works by blocking the reuptake of norepinephrine in the brain, allowing norepinephrine to work longer. Increased norepinephrine in the brain helps with sustaining attention and impulsivity. Atomoxetine is now approved as a first line therapy for ADHD. The drug comes as an oral form you take once or twice per day. Atomoxetine has been found to be only about two-thirds as likely to be effective as stimulant medications. After starting atomoxetine, it may take up to 6 weeks before it reaches its maximum effectiveness.The leading concern for Straterra is some potential for causing suicidal thoughts in the first few weeks of treatment though it may be helpful in the treatment of children who have both ADHD and anxiety. Another rare side effect is a history of liver damage in a small number of people. Other side effects are generally mild but can include decreased appetite, upset stomach, nausea or vomiting, tiredness, problems sleeping, and dizziness.Taking atomoxetine with food can help avoid nausea and stomach aches.

Guanfacine ER

Guanfacine ER (Intuniv) is in the group of medications known as alpha agonists. Guanfacine ER may help with memory and behavioral problems as well as improve aggression and hyperactivity. These medications were developed for the treatment of high blood pressure but have also been used to treat children with ADHD who have tics, sleep problems and/or aggression. Long-acting guanfacine is a pill, but it cannot be crushed, chewed, or broken and must be swallowed whole. It does not suppress appetite much, so may be a good choice for children who lost a significant amount of weight when taking a stimulant. Side effects can include sleepiness, headaches, fatigue, stomachaches, nausea, lethargy, dizziness, irritability, decreased blood pressure, and decreased appetite. Although sleepiness occurs in a large number of children when children start taking long-acting guanfacine, it seems to get better as they continue to take it. It may take 3 to 4 weeks to see medication benefit.

Clonidine

Long-acting clonidine (Kapvay) is also FDA approved for the treatment of ADHD. Clonidine ER is used to reduce hyperactivity, impulsiveness, and distractibility in people with ADHD. Other forms of clonidine are used to treat high blood pressure so people taking it for ADHD may feel lightheaded.

Herbs and nutrients that support ADHD symptoms

Even with appropriate treatment, around 20% of all children with ADHD fail to respond to psychostimulants and most responders are still left with some deficits. Others may respond but may also have minor and serious adverse side effects such as reduced growth, sleep disorders, and decreased appetite. Benefits are associated only with dosing, with benefits disappearing with discontinuation of medication. Many patients and parents desire to avoid taking medications if possible, or they have experienced significant side effects leading to cessation of the trial prescription. Individuals who have started medication, and are having benefit with minimal or no side effects, can add specific herbal therapies for enhanced benefit or allowing a reduction in the strength. The majority, if not all of the natural supplements reviewed here, can be taken in conjunction with medication. Research in ADHD has discovered many herbs and supplements which can benefit in the absence of prescription medication.

Acetyl L-Carnitine (ALC): ALC is a common yet exciting nutrient that is shown to increase norepinephrine and serotonin in the brain. ALC is also known to increase the release of dopamine in the striatum and various brain regions as well as increase acetylcholine to solidify memory synthesis. The increase in these neurotransmitters results in a reduction in impulsivity in animal models as well as improvements in children for aggression, attention difficulties, particularly for inattentive type ADHD.

Ashwagandha: Ashwagandha is a wonderful adaptogen to counter stress response by helping to lower cortisol and raise the anti-anxiety neurotransmitter GABA. When Ashwagandha is coupled with Valerian and Bacopa it has been shown to significantly improve reaction time in ADHD children.

Bacopa monnieri: In one impressive study of children between 6-12 years dosing 225mg of Bacopa monnieri daily for 6 months, found significant reduction in ADHD symptoms. Symptom reduction occurred in 93% of children with restlessness, 89% of children with poor self control, 85% of children with inattention, and 67% of children with impulsivity. Bacopa monnieri has been shown to increase brain derived neurotrophic factor (BDNF) which works directly on the dopaminergic system, leading to reduced dopamine levels. Elevated dopamine levels cause restlessness and increased ADHD symptoms. An additional benefit of Bacopa monnieri is that it appears to block some of the potential negative side effects of amphetamines including avoidance responses in animal models.

Baicalin: Baicalin is the active ingredient of the plant scutellaria which has the ability to increase activity of GABA, the leading anxiolytic neurotransmitter. In an animal model, baicalin was also found to increase dopamine levels in the striatum that helps with motivation. Baicalin treatment improved spatial learning memory, decreased hyperactivity, and was effective for controlling the core symptoms of ADHD.

Ginkgo biloba: Ginkgo biloba has also been shown to improve symptoms in ADHD children. Ginkgo is a safe and effective herb for improving oxygen flow to brain tissue. Ginkgo is also known to inhibit the reuptake of the leading neurotransmitter of attention, norepinephrine. Norepinephrine levels increase and are sustained within the space between nerves with the benefit of enhanced focus. Studies on Ginkgo biloba indicate an overall improvement in ADHD scores, as well as scores for hyperactivity, inattention, and immaturity. Ginkgo biloba has also been studied in combination with methylphenidate and showed an increase of 35% in terms of clinical response.

Lemon Balm: Lemon balm can help to increase GABA, an inhibitory neurotransmitter, while significantly improving the ability to focus and reduce hyperactivity in children less than 12 years old. An additional study was done using a combination product of 640 mg valerian root extract WS® 1014 and 320 mg lemon balm extract WS® 1303 (Sandrin®). In this study, the percentage of children having strong/very strong symptoms of poor ability to focus decreased from 75% to 14%, hyperactivity from 61% to 13%, and impulsiveness from 59% to 22%. Parent rated social behavior, sleep and symptom burden showed highly significant improvements.

Mentha spicata L. (spearmint): Spearmint has been shown to increase neurotrophins and has been studied for both ADHD and cognition. Sustained attention was shown to be improved by day 30, with particular improvement in shifting attention and continuous performance. Cognition studies showed marked improvement in working memory and spatial working memory accuracy by 15% and 9% (p<.05). An additional benefit was improved ability to fall asleep and a sense of vigor, as well as improvement in mood and alertness. Of note is spearmint contains the polyphenol rosmarinic acid which is an anticholinesterase as well as an antioxidant. These effects may contribute to improvement in attention and focus as well as the neurotrophic effects.

Passion Flower: Passion flower also helps to increase GABA. In a double-blind, randomized, control trial, passion flower demonstrated significant clinical benefit over 8 weeks, with no significant differences in outcome between children given methylphenidate. In other words, passion flower was able to convey just as strong of results as methylphenidate. Passion flower also resulted in less anxiety and increased appetite compared to those given methylphenidate.

Probiotics: Recent findings have emphasized the importance of the gut microbiome on health. One such example is serotonin, of which 90% is synthesized in the gut, suggesting that treating the microbiota can have therapeutic effects in modulating serotonin levels which affects mood as well as gut motility. While probiotics have great evidence for helping with anxiety and depression, they also have evidence of helping mood in ADHD patients. Additionally, a study of infants’ gut microbiome showed lower B. longum levels in those who developed ADHD later in life.

  • Longum: 30 days of supplementation resulted in significant declines in negative mood and distress. Also was shown to decrease cortisol levels in urine, indicative of reduced stress. 
  • Heveticus: 30 days of supplementation resulted in significant declines in negative mood and distress. Also was shown to decrease cortisol levels in urine, indicative of reduced stress.

Pycnogenol: Pycnogenol has been shown to increase nitric oxide synthesis, which is involved in modulation of neurotransmitters of attention namely, dopamine and norepinephrine). Pycnogenol administration significantly reduced the hyperactivity and improved attention and visual-motoric coordination and concentration of children with ADHD.

Saffron: Crocus sativus, or saffron, is a spice noted for its antidepressant effects. More recently, saffron has been shown to have the same efficacy in the treatment of ADHD as methylphenidate.

Tyrosine: Tyrosine is an amino acid that is the precursor to both dopamine and norepinephrine. Tyrosine is available from the diet but it can also be dosed as an over-the-counter supplement with the intent of raising the excitatory neurotransmitters. Tyrosine gets converted to L-DOPA (dihydroxyphenylalanine) by the enzyme tyrosine hydroxylase. L-Dopa is converted to norepinephrine via DBH (dopamine beta-hydroxylase). Norepinephrine (NE) is vital for optimal concentration and memory, but also plays a significant role in our response to acute stress. In an ADHD trial of individuals ages 4-18, 67% of participants showed significant improvement with amino acid supplementation. The leading concern for dosing of the amino acid Tyrosine is in patients who have impaired DBH activity. These patient’s lack the enzyme to convert dopamine to norepinephrine, and thus amino acid supplementation leads to elevated dopamine which exacerbates ADHD symptoms.

Valerian: Valerian can help to increase GABA and significantly improves the ability to focus and reduce hyperactivity in children less than 12 years old.

Vitamin B6(P-5-P): Vitamin B6 is a cofactor of the CBS gene that is associated with ADHD. Vitamin B6 is also needed for the production of serotonin and also helps increase inhibitory neurotransmitter GABA.

Vitamin C: Vitamin C is well known as an antioxidant but also serves as a co-factor in the synthesis of norepinephrine from dopamine.

Vitamin D: Vitamin D activates multiple pathways associated with neurotransmitter synthesis and brain development. Vitamin D deficiency has been associated with ADHD-like behaviors.

Zinc: Zinc is an important cofactor for cognitive development, for building  as it builds scaffolding proteins and supports the synthesis of special neuronsfor . Zinc research shows decreases in hyperactivity and impulsivity but not inattention. In other studies, zinc combined with methylphenidate, allowed a 25% reduction in the dosing of stimulant medication.

Precision testing for diagnosis and treatment of ADHD

Food Allergy IgG

A 25 year study reveals that 95% of the population has what is known as a Type II toxic reaction or IgG response to common everyday foods that we eat regularly. Unfortunately, the foods that cause this toxic shock vary widely according to genetics, lifestyle, environment, and individual weakness. In addition, many IgG  reactions are delayed reactions, so they are very difficult to detect on our own. More than 75 symptoms are associated with food toxicities. Perfectly healthy foods can be virtual poison to our particular system. The latest trendy diets may be good for general information, but everyone’s system is different, so you want to find out which foods are toxic to your particular system. Eliminating food IgG response allows us to  be healthier and more energetic, and alleviate many unexplained and chronic symptoms. The following conditions have improved with food IgG testing and elimination: Attention Deficit Disorder (ADHD), Arthritis, Autism, Asthma, Candidiasis, Celiac, Chronic Fatigue Syndrome (CFS), Depression, Diabetes, Digestive Disorders, Ear Infections, Eczema, Fibromyalgia, GERD, G.I. Disorders, Headaches & Migraines, Heartburn, Irritable Bowel Syndrome (IBS), Joint & Muscle Pain, Leaky Gut, Mental Fatigue, Molds, Obesity, Poor Memory, Psoriasis, Sinusitis, Skin Disorders, Weight Loss, and Yeast Infections

Food Additives

Food intolerance(IgG) and food allergen(IgE) testing provide significant clarity to symptoms caused by food reactions. The newest advancement in discovering diet based reactions now includes the Vibrant Additives Test which evaluates 57 common additives as found in many new health foods. Testing for food additives compliments food allergy testing and measures IgG and IgA sensitivity to food additives, which produce histamine type reactions. Symptoms of food additive reactions are similar to many food reactions and include: ADHD, brian fog, gas and bloating, fatigue, abdominal pain and cramping, diarrhea or constipation, headaches, rashes or eczema, nausea, urticaria, bronchitis and asthma-like symptoms, joint pain, muscle stiffness, nerve tingling and numbness. Food additive testing categories include food dyes and pigments, pesticides, sweeteners, elements, preservatives and antioxidants, emulsifiers and surfactants, flavor enhancers, gums and thickening agents, and fibrous additives.

Organic Acid Testing (OAT)

The Organic Acids Test (OAT) provides a metabolic “snapshot” of products the body discards during urination. These small organic acid molecules are byproducts of human cellular activity, the digestion of foods, and the life cycles of gastrointestinal flora, including yeast. The OAT reliably detects the overgrowth of yeast and bacteria species commonly missed by conventional culture methods. These organisms can produce or exacerbate symptoms in many conditions and often affect other metabolic processes also assessed in the OAT. Additional pathways of interest include products of carbohydrate digestion, mitochondrial function, which produces energy at a cellular level, many vitamin levels, neurotransmitter metabolites, as well as an assessment of potential environmental toxicities affecting antioxidant levels. This test may be recommended by your physician if you are suffering with poor memory or focus, mood disorders, autism, or ADHD.

Genetic Testing

No matter your age, race, or gender, understanding your genomic profile provides a more precise guide for you or a child as you care for the body and mind. The physicians of EVND use the IntellxxDNA test to provide comprehensive, clinical-focused knowledge of health risks and benefits within your personal genetic make-up. Our reports are a foundation for planning your personalized approach toward optimal health, wellness and an improved quality of life. With the right genetic testing you can learn how to support your body using personalized nutrition, vitamins and supplements, as well as lifestyle changes to reduce the need for medications. The process reduces frustration, time, and money by using state-of-the-art advanced genomic technology to avoid unnecessary typical, trial and error approach to treatment. Genetic testing provides information on the pathways that influence expression of ADHD symptoms.

References