ADHD Without Drugs
By Gail Szakacs, MD Nancy O’Hara, MD
terized by impulsivity, inattentiveness, and hyperactivity. According to Swanson et al. in Neuropsych Review in 2007, there has been a 400% increase in ADHD over the past 20 years and a 7-fold increase in prescription medications for ADHD. Although it is largely diagnosed in children or adolescents, ADHD also affects adults, and the negative impact it can have on learning, school or work performance, and personal relationships, is universal.
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Pharmaceuticals often mask signs and symptoms of underlying medical problems and thus may be ineffective. In people who have comorbid psychiatric illnesses, medi- cations used for ADHD (usually stimulants) can even be dangerous. Studies by DuPaul et al., and Piska, also show that stimulants are ineffective in 70% of ADHD children with comorbid anxiety. Furthermore, ac- cumulating evidence suggests the etiology of ADHD is multifactorial and may not always respond to stimulant medication. Potential etiologic factors include, but are not limited to, nutritional deficiencies and imbalances, impaired detoxification, allergies and im- mune dysfunction, gastrointestinal disorders, and mitochondrial dysfunction. The expanding ADHD population, scope of potential contributing factors, and increasing reliance on often ineffec- tive medication, signals the demand for a more individualized and comprehensive approach. Underlying medical issues often trigger internal dysregulation in one or more organ systems that manifests as changes in behavior and cognition. Finding and treating
34 Natural Nutmeg April 2012
ttention Deficit Hyperactivity Dis- order (ADHD) is an increasingly common behavioral disorder charac-
these problems often improves behavior and cognition, which promotes more effective learning and greater success in many areas of life. This article highlights aspects of the
integrative approach to ADHD, concentrat- ing on diet/nutrition and toxins as potential underlying contributing factors. Everything presented here is only meant for information and education, not direct diagnostic or treat- ment recommendations.
Diet And Nutrition:
Subtle dietary changes can promote significant behavioral and cognitive changes. The impact of early poor nutrition de- pends on timing in relation to critical brain development, but if poor nutrition contin- ues or develops later, it can have profound negative effects. As far back as 1922, there were published reports of improvement in hyperactivity and learning issues with an elimination diet (Shannon WR). Feingold’s work in the 70s also highlighted the rela- tionship between hyperactivity and artificial food colorings, flavorings, preservatives, and salicylates. The relationship between dietary pep- tides (like gluten and casein) and neurologic function and behavior is well documented as well. Horvath, et al., and others, have shown that increased intestinal permeability can allow poorly digested peptides (as well as toxins and allergens) into the bloodstream where they trigger inflammation, immune dysregulation, and affect neurologic and psychologic function. In 2006, Niederhofer showed that ADHD-like symptomatology is often present among untreated celiac disease
(lifelong gluten intolerance) patients and a gluten-free diet improves those symptoms. In terms of general nutrition, vitamins
and minerals are essential to cognitive func- tion. Various researchers have found low levels of vitamins and minerals in children with a range of neurodevelopmental disor- ders, as well as cognitive, behavioral, and academic improvement in those receiving specific supplementation. Some of that research is introduced below.
Iron:
• Children with moderately severe iron- deficiency anemia as infants had lower test scores for mental and motor function- ing at school entry (Lozoff, et al. 1991 NEJM;325(10):687-694). • 23 children with ADHD, ages 5 to 8, with serum ferritin (iron stores) < 30; for 12 weeks, 18 given iron-sulfate and 5 given placebo; decreased ADHD rating scales (Konofal E, et al. Jan 2008 Pediatr Neu- rol;38(1):20-6). • 73 girls with low serum ferritin; 8-week study; assigned ferrous sulfate or placebo; iron group performed better on verbal learn- ing and memory tests (Bruner AB, et al. Oct 1996 Lancet;348(9033):992-6).
Essential Fatty Acids:
• Study with 44 hyperactive children and 45 matched controls; various essential fatty acid levels were significantly lower in hyperactive group (Mitchell EA, et al. 1987;26:406-411). • Randomized, double-blind, placebo-con- trolled 6-week pilot trial; effects of omega-
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