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ADHD: Are Drugs & Pyschotherapy The Only Choices?

“There is no evidence that dietary supplements such as fatty acids (omega 3 or omega 6) or cutting out foods containing artificial colouring and other additives can help children with ADHD.” (1)

National Institute for Health and Clinical Excellence (NICE) – 24 September 2008

When I showed this paragraph to a friend of mine whose son has been diagnosed with ADHD, her exact words were: ‘But it’s not true’ - in her experience cutting out certain foods has made a difference to her son. 

So what’s going on?

Attention Deficit Hyperactivity Disorder (ADHD) is a controversial topic, with opinion running all the way from ‘it’s just bad parenting’, to general medical opinion viewing it as a defined disorder which can be treated through pharmaceutical intervention (drugs) or psychotherapy. Some even think that ADHD as a condition has been concocted by psychiatrists in the USA who needed a defined medical condition in order to bill insurance companies for their time.

Whichever side of the fence you sit on, there is no doubt that growing numbers of our children are behaving in a manner that parents, and society at large, find difficult to understand.

Whether you blame bad parenting or believe ADHD is a medical condition, record numbers of our children are being drugged, socially stigmatised and psychoanalysed – and it’s a growing trend.

Is there an alternative view?

There’s a question that needs to be asked: why the big rush on the part of schools and organised medicine to drug our kids and make them feel socially abnormal? Has society become lazy in seeking answers to the ADHD question? Or do large, powerful and conservative health organisations dominate (with the best intentions or otherwise) the ADHD conversation and research? 

Persistent hyperactive and inattentive behaviour could be caused by a huge range of factors, from dopamine receptor problems to bad parenting to iron deficiency to toxic metal interference to nervous system malfunction - there could be 10 or 100 causes or contributing factors to hyperactive and inattentive behaviour in children.

Any of these multiple factors may be at play in any given child at any one time. 

So with heavyweight institutions rolling out the red carpet for pharmaceutical products and psychotherapy the world over, what are the alternative, or at least complimentary approaches, that you don’t see covered in the news?

Alternative approaches to ADHD

There is a body of emerging research and anecdotal evidence which suggests methods considered ‘alternative’ or ‘complimentary’ by the standards of established medical practice might well be worth exploring if your child is persistently inattentive or hyperactive.

For the most part, these are centred around what we eat day to day and how imbalances in our foods might lead to fatty acid, toxic metal, essential mineral and cellular energy imbalances:

High mercury levels

The mercury in amalgam tooth fillings and vaccines, not to mention from our polluted seas in the form of the fish we eat, could affect the nervous system in some children sensitive to mercury. Certainly there is some evidence to suggest that even slightly increased levels of mercury could be related to ADHD behaviours.

A 2006 study, predominantly in 7 year old boys, showed that children with mercury blood levels slightly higher than average had a much stronger chance of having ADHD than children without. The study concludes:

“High blood mercury level was associated with ADHD”(2)

Low iron levels

Iron levels in children with ADHD have been shown to be lower than those without ADHD. The severity of symptoms has also been linked to the amount of iron found in children - the lower the iron level, the more severe the symptoms of ADHD.(3)

A clinical study published in 2008 looked at the effect of iron supplementation in children with low iron levels who had been diagnosed with ADHD. Each child was given 80mg of ferrous sulphate per day or placebo (dummy therapy) for 12 weeks.

The results showed significant improvements in ADHD behaviours in the children taking the 80mg of iron, while those taking the placebo showed no improvement.

Although we don’t know yet why iron is beneficial in treating ADHD, we do know it plays an important role in dopamine activity (a brain chemical), which in turn has been suggested as an important factor in ADHD.(4)

Iron can also protect us from the toxic affects of lead,(5) so where there’s a low level of iron in our bodies, our nervous system might be more exposed to its toxic effects,(6,7) and this could be a significant factor in triggering ADHD behaviour.

Since excess levels of iron can damage our bodies, it is important that iron levels be measured prior to supplementation.

High levels of lead

Central nervous system exposure to lead can affect dopamine release in our brains and the ability of our dopamine receptors to detect this important hormone. This effect has been put forward as a factor that contributes to ADHD.(8,9,10)

The effectiveness of our blood-brain barrier (part of our central nervous system which restricts the passage of various chemicals into our brain tissue) is also essential when it comes to how effective our brains are. Lead may disrupt and damage the structure of this barrier while iron protects it.(5,11)

High copper levels with low sulphur

This particular imbalance has been noted as one of the most common causes of ADHD behaviour, with symptoms including a ‘foggy’ mind, poor memory and lack of concentration. Foods high in copper include cocoa and chocolate products, coffee, tea, soy, liver, nuts, seeds, shellfish and wheat germ.(12)

Calcium and magnesium deficiencies

Deficiencies in both of these essential minerals have been put forward as another leading cause of ADHD behaviour.(12,13) If a person is extremely ticklish, craves chocolate and/or milk, is unable to disregard unimportant stimuli, has muscle cramps and trouble relaxing or going to sleep, any of these can suggest low magnesium and calcium.(14)

Hair Mineral Analysis

One way of measuring the levels of all the metals and minerals mentioned above is through Hair Mineral Analysis (HMA – in the interests of transparency we should note that 3D Personal Training offers HMA services). The advantage of HMA is that it offers a measure of many minerals and metals, and the significant imbalances between them in one single hair test. It’s also relatively cheap and non-invasive compared to blood sampling. Properly taken samples offer a good reflection of metabolic activity over a sustained period of time and allows for appropriate supplementation to be tailored to the needs of the individual.

The levels of lead in hair has previously been used in scientific research which found ADHD to be related to lead,(15) and some paediatricians have found hair to be more helpful than blood samples when looking at mineral deficiencies. Still, as with most tests it is not perfect and although at 3D Personal Training we think it’s a very useful tool, it does have certain draw backs (being hair, for instance, it’s somewhat open to external environmental contamination).

Food additives

A 2007 study involving ‘normal’ children (not showing ADHD symptoms) commissioned by the UK Food Standards Agency (FSA), and published in the respected medical journal The Lancet, found:

“Artificial colours or a sodium benzoate preservative (or both) in the diet result in increased hyperactivity in 3-year-old and 8/9-year-old children in the general population.”(16)

That’s sounds like ADHD behaviour to us. And it begs the question: if these additives have this effect on children without ADHD, what on earth might they do to kids who do have a tendency for ADHD behaviour?

For clarification, the study tested preservative E211 (sodium benzoate) and food dyes E102 (tartrazine), E104 (quinoline yellow), E110 (sunset yellow), E122 (carmoisone), E124 (ponceau 4R) and E129 (allura red). These were just the additives the study tested. There are many, many more that were not.

In addition, the FSA noted:

“…if a child shows signs of hyperactivity or Attention Deficit Hyperactivity Disorder (ADHD) then eliminating the colours used in the Southampton study from their diet might have some beneficial effects.”

We think that’s an understatement.

Essential Fatty Acids (EFA’s) – Omega’s 3 & 6

It’s well documented that children with ADHD show lower levels of EFA’s than those without. This may be due to low dietary intake, poor breakdown of these fats into forms our bodies can use, or that some people burn fats faster, and therefore need more than others. Tell tale signs of a deficiency are excessive thirst, dry skin and hair, brittle nails and frequent urination.

It’s the ratio between omega 3 and 6 fats that matters though, and many children with ADHD have been shown to have a ratio a long way from the 2:1 ideal. In fact, many people today have ratios more like 1:15 or 1:30. The impact of this imbalance on mental health stretches way beyond ADHD.

This ratio imbalance must be addressed for EFA supplementation to be successful, and most of the studies which have looked at fatty acids have neglected this point. Only two have done so, one of which did not sufficiently address this imbalance (a decrease of 33.04 to 15.19 over four months),(17) and another which although encouraging was not large enough and did not contain a placebo or control group.(18)

This last study concludes that greater doses of omega 3 are needed to redress the imbalance to under 1:3 in order to show significant behavioural improvements. It’s a step in the right direction at least and suggests that omega 3 supplementation is the way forward.

Omega 3 oils are found in flax seeds (best ground fresh and eaten right away), walnuts and their oil, and fish oils. The blockbuster omega 3 oil is Antarctic Neptune Krill Oil, but Udo’s Choice Ultimate Oil Blend is also high quality.

Tyrosine deficiency

Tyrosine is an amino acid which helps our bodies to synthesise norepinephrine and dopamine, two hormones connected with ADHD. Norepinephrine is used by the brains’ limbic system to filter out non-essential stimuli and so a deficiency might well lie behind hyperactive and inattentive behaviour.

Carbohydrate metabolism

Could an imbalance of carbohydrates, proteins and fats in our diets also lead to a lack of energy in our brain cells, causing ADHD behaviours? The practices of biochemical individuality and metabolic typing suggest that all of us burn energy at different rates and that this is highly individual, with some of us burning carbohydrates extremely quickly and some of us burning them slowly.

In his book ‘Nutrition and Your Mind’ Dr George Watson talks at great length about dietary imbalances and how these can result in mental health issues:

‘Since acetate is the most important energy-producing compound in the tissues, one should not be surprised to find that rather severe personality changes can be induced by a diet very low in fat and very low in protein, the two best sources of acetate.’(19)

If your child craves simple sugars and carbohydrates, such as fruit juice, cereals, fruit, sweets, white bread, white rice and potatoes, a diet higher in good fats and protein may be of benefit.

Stable blood glucose levels are important to any child’s behaviour, and especially those with ADHD. Try following a diet much like the elimination diet on our website, which gets rid of many additives and preservatives as well as simple carbohydrates for a limited period of time, allowing you to see the reactions of re-introducing these types of foods back into your child’s diet.

Spinal alignment problems

Spinal alignment problems in the thoracic spine at vertebrae T4-T6 have been associated with ADHD behaviour,(12) and many holistic minded chiropractors and osteopaths may be able to offer further help and advice. We’ve heard of at least short term success through this approach.

Lets just take a moment to re-read part of the recent National Institute for Health and Clinical Excellence guidance for treatment of ADHD:

“There is no evidence that dietary supplements such as fatty acids (omega 3 or omega 6) or cutting out foods containing artificial colouring and other additives can help children with ADHD.” (1)

Are the only choices drugs and psychotherapy when it comes to ADHD?

We’ll leave you to decide.

Yours in health,

Craig Burton and Matt Brereton-Patel. 

References:

1. http://www.nice.org.uk/Guidance/CG72/PublicInfo/pdf/English
2. Cheuk DKL, Wong V. Attention-Deficit Hyperactivity Disorder and Blood Mercury Level: a Case-Control Study in Chinese Children. Neuropediatrics 2006;37:234-240
3. Konofal E, et al. Iron deficiency in children with attention deficit/hyperactivity disorder. Arch Pediatr Adolesc Med. 2004;158(12):1113-5
4. Konofal E, et al. Effects of Iron Supplementation on Attention Deficit Hyperactivity Disorder in Children. Pediatr Neurol, 2007;38(1): 20-26
5. Wang Q, Luo W, Zheng W, Liu Y, Xu H, Zheng G, et al. 2007. Iron supplement prevents lead-induced disruption of the blood-brain barrier during rat development. Toxicol Appl Pharmacol 219(1):33–41.
6. Wright RO. 1999. The role of iron therapy in childhood plumbism. Curr Opin Pediatr 11(3):255–258.
7. Wright RO, Tsaih SW, Schwartz J, Wright RJ, Hu H. 2003. Association between iron deficiency and blood lead level in a longitudinal analysis of children followed in an urban primary care clinic. J Pediatrics 142(1):9–14.
8. Swanson JM, Kinsbourne M, Nigg J, Lanphear B, Stefanatos GA, Volkow N, et al. 2007. Etiologic subtypes of attention-deficit/hyperactivity disorder: brain imaging, molecular genetic and environmental factors and the dopamine hypothesis. Neuropsychol Rev 17(1):39–59.
9. Gedeon Y, Ramesh GT, Wellman PJ, Jadhav AL. 2001. Changes in mesocorticolimbic dopamine and D1/D2 receptor levels after low level lead exposure: a time course study. Toxicol Lett 123(2-3):217–226.
10. Lidsky TI, Schneider JS. 2003. Lead neurotoxicity in children: basic mechanisms and clinical correlates. Brain 126:5–19.
11. Dyatlov VA, Platoshin AV, Lawrence DA, Carpenter DO. 1998. Lead potentiates cytokine- and glutamate-mediated increases in permeability of the blood-brain barrier. Neurotoxicology 19:283–291.
12. http://www.acu-cell.com/dis-add.htm
13. http://www.drbriffa.com/blog/2001/08/07/hyperactivity-a-natural-drug-free-approach/
14. http://articles.mercola.com/sites/articles/archive/2001/01/07/lendon-smith.aspx
15. Tuthill RW. Hair lead levels related to children’s classroom attention-deficit behaviour. Arch Environ Health 1996;51:214-220
16. McCann D, et al. Food additives and hyperactivity behaviour in 3-year old and 8/9 year old children in the community: A randomised double -blind-placebo controlled trail. Lancet 2007; 370: 1560-67
17. Steven L, et al. EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviors. Lipids 2003, 38:1007-1021.
18. Sorgi P, et al. Effects of an open-label pilot study with high-dose EPA/DHA concentrates on plasma phospholipids and behavior in children with attention deficit hyperactivity disorder. Nutrition Journal 2007, 6:16 http://www.nutritionj.com/content/6/1/16
19. Watson G, Nutrition and Your Mind. Harper & Row 1972