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Comprehensive Individual Healthcare for All Ages

Integrative Health Update
L. Zaiim MD, February 2011

Attention Deficit Hyperactivity Disorder

DEFINITION

Also known as ADHD or AD/HD or ADD this most common of childhood psychiatric disorders is a neurobehavioral and developmental disorder. Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD starting before seven years of age. The symptoms of ADHD can at times be difficult to define because it is hard to draw the line at where normal levels of inattention, hyperactivity, and impulsivity end and clinically significant levels requiring intervention begin. To be diagnosed with ADHD, symptoms must be observed in two different settings for six months or more and to a degree that is greater than other children of the same age.

ADHD is the most commonly studied and diagnosed psychiatric disorder in children, affecting about 3 to 5 percent of children globally and diagnosed in about 2 to 16 percent of school aged children. It is a chronic disorder with 30 to 50 percent of those individuals diagnosed in childhood continuing to have symptoms into adulthood. Adolescents and adults with ADHD tend to develop coping mechanisms to compensate for some or all of their impairments. It is estimated that 4.7 percent of American adults are estimated to live with ADHD.

ADHD is diagnosed two to four times as frequently in boys as in girls, though studies suggest this discrepancy may be partially due to subjective bias of referring teachers. ADHD management usually involves some combination of medications, behavior modifications, lifestyle changes, and counseling. Its symptoms can be difficult to differentiate from other disorders, increasing the likelihood that the diagnosis of ADHD will be missed in some cases while in others it may be over diagnosed.

Stimulants, such as Ritalin and Adderall, form the core of conventional treatment of ADD/ADHD and we now consume over %80 of the world’s stimulants.

NON CONNVENTIONAL TREATMENTS

The following are the list of some of research based non-conventional treatments modalities which can be incorporated into treatment plans of patients with ADD/ADHD.

I. EEG Biofeedback (AKA Neurofeedback)

In this treatment modality children receive biofeedback training to modulate their own EEGs. The research done on this method is quite promising, but it takes many sessions and can be quite costly.

II. Vitamins/Minerals

Studies indicate a benefit to nonverbal intelligence/academics with a simple multivitamin and mineral supplement. Another investigator found the evidence was best for zinc supplementation in the treatment of ADD/ADHD.

A researcher also found a significant number of ADHD children had depressed ferritin and iron levels and also that supplementation improved performance. Vitamin and mineral supplementation is and has no down side. A daily multivitamin plus separate calcium/magnesium, B-6 (50 mg), and zinc (25mg) compromises my basic recommendation.

III. Essential Fatty Acids (EFAs)

Eicosanoids that are produced from EFAs control the functioning of the pervasive prostaglandin system. These hormone-like substances mediate physiological functions throughout the body. ADD/ ADHD children often have deficient patterns of EFAs in their plasma. The associated symptoms are dry skin, increased thirst, frequent urination, eczema, and asthma. Other symptoms of this imbalance are somatic complaints (headaches, stomachaches, diarrhea, constipation, or insomnia).

I generally recommend supplementation with 1,000 mg of combined EPA/DHA once or twice daily. Additional vitamin E (400 IU/d) is also recommended when using EFAs.

IV. Mentalin

This proprietary Ayurvedic preparation, which contains the herbs gotu kola, ginger, and bacopa, has shown some research efficacy in India. In my experience, it works well for mild to moderate cases of ADD/ ADHD by providing a centering, calming effect. Dosage is two to four tablets twice daily. A similar liquid product called Kid Power (Naturalhealingdoctor.com) is also available. This preparation may be used as an alternative in patients who experience side effects to conventional medications.

V. Other Treatment Considerations

i. Thyroid hormone resistance: There seems to be a correlation of resistance to thyroid hormone and ADHD. If the child has a positive family history of thyroid disorder or clinical indicators, laboratory evaluation and appropriate treatment are indicated.

ii. Diet: I consistently recommend that parents clean up their child's diet by reducing sugar, preservatives, dyes, and caffeine. I always recommend a high protein breakfast and more whole grains. Soda has no place for these kids. These simple changes can often make very significant changes in behavior and attention for challenged children.

Integrative Health Update
May 2011

The Top Ten Supplements I Recommend:

1. Vitamin D3 – 5,000 IU/day, 1 tablet
Called the “master key to optimum health,” vitamin D controls the expression of more than 1,000 genes throughout the body, notably in the immune system, in endothelial cells lining blood vessels, pancreatic beta cells, and brain neurons. Vitamin D also expresses genes that blunt the immune system-mediated inflammatory response that propagates atherosclerosis and congestive heart failure. For most people the dose needed to reach an optimal vitamin D blood level (25-hydroxyvitamin D) of 50 ng/ml is 5,000 IU/day, ten times the government’s recommended dietary allowance (RDA). People with cancer, chronic illness, and neurodegenerative diseases should take sufficient vitamin D to attain a level of 80 ng/ml (which requires 8,000-10,000 IU/day).

2. Iodine – 12.5-15 mg/day — one Iodoral tablet
Iodine taken in doses 100 times the RDA (100-150 micrograms/day) has important thyroidal and extra-thyroidal benefits. These include its role as an antioxidant, in preventing and treating fibrocystic disease of the breast, and in preventing and treating cancer. In the right dose, iodine helps keep the immune system healthy, and it provides antiseptic mucosal defense in the mouth, stomach, and vagina.

3. Selenium – 200 mcg/day, as selenomethionine, 1 tablet
Selinium is the active site in some 35 proteins and plays a major role in free radical defense. People deficient in selenium have an increased risk of cancer. Selenium prevents cancer through a variety of mechanisms, which include antioxidant protection, enhanced immune surveillance, suppression of angiogenesis, regulation of cell proliferation, enhancement of apoptosis (cell death), and inhibition of tumor cell invasion.

4. Vitamin K2 – 90 mcg/day, as menaquinone-7, 1 tablet
Vitamin K comes in two basic forms, K1 and K2. K1 is a cofactor for blood coagulation. K2 activates a protein secreted by osteoblasts that plays a role in bone mineralization and calcium ion hemostasis. Calcium deposits in the walls of blood vessels play an active role in the formation of atherosclerosis. K2 activates a protein which enables it to bind and remove calcium from blood vessels and thus prevent the formation atherosclerotic calcific plaques. Vitamins D and K2 work together in this regard. Menaquinone-7, the natural form of vitamin K2, is better than synthetic menaquinone-4, the more widely marketed form of vitamin K2.

5. Magnesium (Mg) – 900 mg/day, in 6 tablets of Magnesium Citramate
Magnesium ions are essential to the basic nucleic acid chemistry of life, and 80 percent of the enzymes in the body need Mg in order to function. Mg deficiency can affect every organ system in the body. In skeletal muscles, Mg deficiency causes twitches, cramps, back aches, neck pain, tension headaches. With the heart Mg deficiency can cause angina (from spasm of the coronary arteries), high blood pressure, and rhythm disturbances, including sudden death.

6. Alpha Lipoic Acid (ALA) – 600 mg/day for men; 300mg/day for women; along with Acetyl-L-carnitine and Propionyl-L-carnitine or 300 mg
ALA is one of the most powerful antioxidants in the body and in addition it restores the four other network antioxidants when oxidized (vitamin C, vitamin E, coenzyme Q10, and glutathione) back to their functional, reduced antioxidant state. ALA aids glucose entry into cells, improves insulin sensitivity, and reduces the risk of diabetes. It protects brain cells by blocking excitotoxicity, chelates (removes) mercury from the body, and reduces the risk of atherosclerosis. ALA also plays an integral role in producing the energy molecule adenosine triphosphate (ATP).

7. Coenzyme Q10 (CoQ10) – 400 mg/day, as Ubiquinol
CoQ10 is a vitamin-like compound. The body synthesizes it, but in insufficient quantities, especially in people who take statins like Lipitor to lower cholesterol. It is a strong antioxidant and removes oxidized low-density lipoproteins (LDL), a leading culprit in atherosclerosis. CoQ10 also plays a critical role in mitochondrial energy production. It is a necessary ingredient in the electron transport chain that produces ATP through oxidative phosphorylation. A central event in chronic degenerative diseases is the loss of a cell’s ability to produce sufficient energy. The hearts in people with congestive heart failure, and the brains in those with Parkinson’s disease lack CoQ10 High doses of this supplement (800-1,200 mg/day) effectively treat these diseases. Even in these doses CoQ10 has no side effects or toxicity. Ubiquinol is the reduced, antioxidant form CoQ10.

8. L-Carnitine – 660 mg/day
Fats supply most of the fuel that heart muscle cells use, and this compound is needed for cells to metabolize fats. L-carnitine transports long chain fatty acids, which, by weight, have a double concentration of calories (compared with carbohydrates and proteins) into mitochondria, where they are converted into ATP. As is the case with CoQ10, people with congestive heart failure also have low levels of L-carnitine in their heart muscle cells.

9. Omega 3 fatty acids: EPA eicosapentaenoic acid) – 850-1080 mg/day ; DHA (docosahexaenoic acid) – 1,050 mg/day (in 2 tsp Quantum Cod Liver Oil)

These two essential, Omega-3 fatty acids promote cognitive and neurological health, and they prevent heart disease and cancer. DHA influences brain cell signaling, receptor expression and function, and neurotransmitters. It stimulates neurite outgrowth and synaptic development and repair (brain plasticity). EPA thins the blood. Both regulate the expression of many genes involving antioxidant capacity and oxidative stress response, others that control cell signaling and proliferation, and genes that produce chemicals which reduce inflammation and improve blood flow through the coronary arteries and other blood vessels.

10. Resveratrol 100 mg/day
This anti-aging agent, found in red grapes, extends the life span of yeast (by 70%), roundworms, fruit flies, and mammals (as seen in studies done with mice). Notably among its effects, resveratrol is a potent antioxidant, an anti-inflammatory agent (COX-inhibitor), liver detoxifier, brain plaque cleanser, and mineral chelator. It also normalizes blood sugar.

Reference: See Dr. Jonathan Wright’s Articles on Supplements