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Advances in Nutritional Therapy for Attention Deficit Hyperactivity Disorder

July 2005

By Laurie Barclay, MD

Recent advances in understanding the origins of attention deficit hyperactivity disorder (ADHD) may allow symptoms to be managed with nutritional therapy and without the adverse side effects of commonly prescribed stimulant drugs such as Ritalin®. Essential fatty acids, B vitamins, choline, phosphatidylserine, amino acids, zinc, and herbal extracts all show promise in managing symptoms of ADHD.

Understanding ADHD

In the past, children’s discipline problems, poor grades, and roughhousing with playmates might be dismissed as “rambunctious behavior.” The growing trend today, however, is to label increasing numbers of children—and even adults—with the psychiatric diagnosis of attention deficit hyperactivity disorder, or ADHD.

At least 3-10% of children and 1-6% of adults in the US have been diagnosed with ADHD.1-4 Boys diagnosed with ADHD outnumber girls by a ratio of three to one. Symptoms of ADHD include an inability to concentrate or complete tasks, hyperactivity, compulsive or impulsive behavior, temper flares and mood swings, problems with short-term memory and learning, clumsiness, and distorted perception of time.3,5

ADHD affects school performance,6 social adjustment, and the likelihood of cigarette smoking and substance abuse.2 In a follow-up study of 55 young adults at the age of 22 who were diagnosed with ADHD at the age of seven, 58% had poor outcomes, including antisocial personality, alcohol abuse, criminal record, reading disorders, and low educational level.7 “Childhood ADHD . . . appears to be a most important predictor of poor psychosocial functioning in early adulthood,” the investigators concluded. “It would seem appropriate to screen for such disorders in schools and clinics so that therapies may be started early.”7

Although conventional pharmacological treatment of ADHD with stimulant drugs reduces symptoms of inattentiveness and hyperactivity, the most commonly prescribed, amphetamine-like drugs such as Ritalin® (methylphenidate) have the potential for addiction, growth suppression,2 and other serious complications.8,9

In a study of more than 200,000 preschoolers in three different health care settings, about 12% were prescribed stimulant drugs, and 90% of these prescriptions were for Ritalin®. Even more frightening, from 1991 to 1995, the use of Ritalin® tripled in 2- through 4-year-olds,10 and by 1997, 2 million US children were being treated with stimulants.2

Nutrients Show Promise

Fortunately, recent advances in understanding the biochemical and neurophysiological roots of ADHD may allow these symptoms to be managed with nutritional therapy, without the adverse side effects of stimulants. Particularly promising are essential fatty acids, B vitamins, choline, phosphatidylserine, amino acids, acetyl-L-carnitine, zinc, and herbal nutrients that improve brain circulation. Because of the numerous and potentially adverse consequences of ADHD if left untreated, nutritional supplementation should be started as soon as possible.

In a recent study, 20 children diagnosed with ADHD were treated with either Ritalin® or food supplements containing a mix of vitamins, minerals, phytonutrients, amino acids, essential fatty acids, phospholipids, and probiotics targeting biochemical risk factors for ADHD.11 Following treatment, both groups of children recorded similar and significant improvements on psychological tests. The results offer support for the effectiveness of food supplements in improving attention and self-control in children with ADHD, and suggest that food supplements may be as effective as Ritalin® in treating ADHD.11

“I have worked with ADHD for over 30 years, which has allowed me exposure to a range of treatments,” study coauthor Richard Judah, PhD, told Life Extension. “For many years, I was skeptical about nutritional supplementation as an effective way of addressing problems of inattention, distractibility, and motor-impulse control.”

Dr. Judah, a psychologist at Vermont College in Brattleboro, adds, however, “I have come to the conclusion that the natural approach can indeed be effective in reducing the symptoms of ADHD. The biggest challenge in providing support for good supplementation to alleviate the condition involves establishing good research protocols to prove and quantify that it works.”

Disconnects in the Neural Network

To be able to detect, discriminate, and respond appropriately to the barrage of sensory information encountered in everyday life, the neural network underlying attention must be intact and functioning properly. Just as severing phone lines and computer cables can significantly affect communication capability, disrupting nerve connections can affect communication in the human brain.

Sophisticated brain-imaging techniques, such as magnetic resonance imaging (MRI) and functional imaging, reveal abnormalities in ADHD patients.12 These abnormalities involve both the gray matter and white matter of the brain.

In the gray matter, tests show that blood flow and energy use are decreased in much the same areas that show anatomical abnormalities—namely, the prefrontal cortex and striatum.3,12 Structural deficits of the white matter are also apparent and may represent breakdown of the protective myelin coating of nerve fibers, which could decrease communication speed.12 These studies also show impaired regulation of neurotransmitters used by nerve cells to communicate with each other, including the catecholamine system, which is crucial to maintaining attention.3

Other studies of children with ADHD support the hypothesis that impaired catecholamine regulation is involved in the development of ADHD.13 This “fight-or-flight” system, which also involves the adrenal gland and its hormones, allows an individual to respond to stress via activation of the sympathetic nervous system, and to fight off or retreat from an attacker or other threat.

Impaired catecholamine regulation of brain areas involved in ADHD may reduce the energy available to brain cells.14

Other research highlights deficiencies in dopamine neurotransmitter systems, which regulate movement and mood, in patients with ADHD.4,8 The inherited basis for ADHD may involve a gene coding for the dopamine D4 receptor,15 or a gene controlling receptors for serotonin, another neurotransmitter.16

Some studies suggest that abnormal genes may interact with environmental culprits to trigger or aggravate ADHD in susceptible individuals. Among these potential triggers: food additives; food intolerances; sensitivities to chemicals, molds, and fungi; heavy metals such as lead; pollutants such as polychlorinated biphenyls (PCBs); and nutritional deficiencies.1,8

“Nutrient deficiencies are common in ADHD; supplementation with minerals, the B vitamins (added in singly), omega-3 and omega-6 essential fatty acids, flavonoids, and the essential phospholipid phosphatidylserine can ameliorate ADHD symptoms,” notes Parris M. Kidd, PhD, in a recent review of the scientific literature on ADHD.8

In correspondence with Life Extension, Dr. Kidd notes, “Many if not all of the drugs used to treat ADHD have poor benefit-risk profiles. An integrated approach using diet, nutritional supplements, and detoxification is consistently effective in benefiting individuals with ADHD. Children are far better served by using nutrients first and turning to pharmaceuticals only as a last resort.”

Limitations of Drug Treatment

Ritalin® and other stimulant drugs that increase dopaminergic activity may improve ADHD symptoms—particularly inattentiveness, hyperactivity, mood swings, and impulsive behavior—in about 60% of patients.2,4 Paradoxically, however, these drugs are unlikely to improve school performance.6 Combining psychosocial interventions with medications may improve response to treatment.3,4,6,17,18

About one third of children with ADHD either do not respond to stimulant drugs or cannot tolerate their side effects.2,19,20 “Psychiatric medication has major risks in children,” cautions Dr. Josep Berdonces of the University of Barcelona in Spain.9 Science journalist Brian Vastag warns that

“Ritalin® acts much like cocaine.”21 In individuals who later develop bipolar disorder, taking stimulant drugs in childhood may cause an earlier onset of the disease.22

Other drugs thought to be effective in some ADHD patients include those affecting the neurotransmitters noradrenaline, dopamine, or acetylcholine; bupropion; tomoxetine;23 atomoxetine;24 theophylline;20 and gabapentin.25 While better tolerated than Ritalin®, these drugs may also be limited by side effects.

Nutritional Therapy for ADHD

Alternative therapies for ADHD include nutritional supplementation, dietary management, exercise and neurofeedback strategies, laser acupuncture, massage, and vestibular stimulation.2,26-28 Some scientists have noted that ADHD is very common among individuals with generalized resistance to thyroid hormone,8 and others have noted that thyroid treatment improves ADHD in individuals with documented thyroid abnormality.26

A study of 114 parents of children with ADHD showed that more than half had used complementary and alternative therapies, such as nutritional supplements, in the past year.29 An Australian study had similar results,30 and a US study showed that about 20% of parents had given herbal therapies to their children with ADHD.31

Because 90% of total brain growth occurs in the first three years of life, nutrients required for its development must be supplied to support optimal brain health in these early years. However, fewer than 1% of US children and adolescents receive the US recommended daily allowance (RDA) for the five food groups (fruits, vegetables, meat, dairy, and grains), and 16% do not consume the RDA of any of the five food groups, according to a US Department of Agriculture survey of 3,300 participants.32

In a controlled study of nearly 500 schoolchildren, those who were randomly assigned to receive daily multi-vitamin/mineral supplements containing 50% of the RDA for four months had a 47% lower rate of antisocial behavior than did those who received placebo.33

“A group of children confined in a psychiatric correctional facility all had clinical signs of poor nutrition that were confirmed with blood analysis,” lead author Stephen Schoenthaler, PhD, a professor of criminal justice at California State University, Stanislaus, told Life Extension. “Correction of those deficiencies with better food and daily supplements produced a reduction in serious violent acts while they were confined, from 137 during the previous three months to nine while under treatment for the next three months.”

“What our research has suggested is that poor nutrition negatively affects a whole host of parameters related to delinquency, including behavior and academic performance issues, which are definitely linked,” coinvestigator Ian D. Bier, ND, PhD, of the Dietary Research Foundation in Durham, NH, told Life Extension. “As nutritional intake is improved, either through diet or nutritional supplementation, you start to see a return to sufficient levels of vitamins in the blood, and correction of these issues.”

Another dietary approach to treating ADHD involves avoiding sugar, sweeteners, and other additives such as dyes and preservatives. While some studies suggest that avoiding food dyes and preservatives can improve ADHD symptoms,9,26,34,35 other studies, particularly those examining the effects of sugar and sweeteners, are inconclusive.36,37

“Although the results of several controlled studies are contradictory, there is no scientific evidence that sugar, artificial food colorings, or sweeteners are responsible for behavior or learning problems in children,” according to Dr. Enrique Chaves-Carballo of the University of Kansas Medical Center’s Department of Pediatrics.38