On November 12, the CDC reported that 10 percent of children in the U.S. have been diagnosed with attention deficit hyperactivity disorder (ADHD), an increase of almost 25 percent in just four years.
Between 2003 and 2007, a million children were given this diagnosis for the first time, raising the number of affected children to 5.54 million. Two-thirds of those children are being treated with drugs to enhance focus and concentration.
But research indicates that two drugs commonly prescribed to treat ADHD, Methylphenidate (Ritalin) and d-amphetamine (Dexedrine), can increase the rate of cigarette smoking. A study done at the University of Kentucky found that use of Methylphenidate increased the total number of cigarettes smoked, number of puffs, and carbon monoxide levels.
There is an effective alternative to drug therapy: nutrition.
A body of scientific research supports the importance of nutritional factors in ADHD. I have personally treated hundreds of children with ADHD over the past 30 years. Almost all have improved without the need for drug therapy. To help them and their parents I have used a series of questions that searches for the causes of ADHD in each individual child.
Parents seeking to learn more about how nutrition may impact their child's behavior can use these questions as a guide:
(1. How nutritious is the child's diet?
Over 50 percent of children with ADHD crave sweets, often at the expense of nutritious food. About 70 percent of children who crave sweets have much more control over their behavior when their food is low in added sugar. My first line of advice to parents is, keep your children away from sugary cereals, pancakes or waffles with syrup, soft drinks, candy, cakes, cookies, doughnuts, ice cream, frozen yogurt and chocolate. Every ounce of sugar reduction helps. Sugar alone does not cause hyperactivity. It reduces the nutritional quality of the diet and may aggravate other food intolerances (see below).
(2. Are there any foods or food additives to which the child is sensitive or intolerant?
During the 1960s, Dr. Benjamin Feingold, a California pediatrician, observed that many hyperactive children became excited after eating foods containing high concentrations of salicylates. These phenolic compounds occur naturally in many fruits and vegetables and are especially concentrated in raisins, nuts, apples and oranges. They are also used as preservatives (BHT and BHA, for example) or as the basis for artificial colors or flavors. Feingold developed a low salicylate diet that has helped many children overcome ADHD. Twenty-five years ago the National Institute of Mental Health convened a consensus panel which concluded that 8 to 10 percent of children with ADHD are sensitive to salicylates and benefit from the Feingold diet.
Shortly afterwards a study was done at the Hospital for Sick Children in London and published in the leading British journal, Lancet, which demonstrated that most children with severe ADHD are salicylate sensitive, but that 90 percent of these children have additional food intolerances. The conclusion is that the Feingold diet will not significantly benefit the majority of children with ADHD because they have more than one type of food sensitivity. The British researchers performed exhaustive dietary trials, closely supervised by hospital dietitians. After determining that 80 percent of the children had apparent food sensitivities as a cause of hyperactivity, they then performed double blind, placebo controlled challenges with the offending foods. Using this most rigorous clinical research method, the investigators confirmed the presence of food intolerance in the majority of children with ADHD.
Subsequent research by the leading investigator of this study suggested that these food intolerances represent true food allergy. The foods to which children with ADHD most commonly had allergic reactions were cow's milk (which included milk, cheese, yogurt and ice cream), corn (an additive in many prepared foods), wheat, soy and eggs. Altogether, 48 different foods were incriminated as triggers for hyperactivity.
In my clinical practice I have found that food allergy is especially likely to be implicated in ADHD if the answer to any of these questions is positive:
(A) Does the child have eczema, asthma, hay fever, hives or a chronic runny nose?
(B) Does either a parent or a sibling have severe allergies or migraine headaches?
(C) Does the child have a "geographical tongue"? (Irregular flattened patches that look like countries on a map.)
(D) Do the child's ears turn red for no apparent reason?
(E) Does the child seem to crave single foods (other than sweets)?
If the answer to any of these questions is positive, I recommend a trial period of two weeks in which the child totally avoids all foods containing artificial colors, artificial flavors and preservatives and the high frequency allergy foods mentioned above.
The best foods to use during this trial are meat, poultry, fish, rice and rice milk, oats and oatmeal, fresh vegetables and fresh fruits. If this diet works, there will be not only an improvement in concentration and behavior, but other symptoms will improve, symptoms such as itching of the skin, sneezing, wheezing and the sudden red ear attacks.
The two-week trial is followed by a period in which the foods removed are added back, one food each day. If the child experiences hyperactivity, itching of the skin, wheezing, a runny nose or red ears when a particular food is reintroduced to the diet, he or she is likely to be allergic to the food.
(3. Does the child need nutritional supplements?
Hyperactive children often benefit greatly from the right supplements. To develop priorities for supplementation some further questions need to be answered:
(A) Does the child have dry skin, follicular keratoses (tiny rough bumps, usually found on the back of the arms and popularly known as chicken skin), brittle nails, dry and unruly hair or excessive thirst? If so, she or he probably needs a dietary supplement of essential fatty acids. A study done in the Department of Foods and Nutrition at Purdue University found that boys with ADHD had significantly lower concentrations of essential fatty acids in their blood than a control population. The lowest levels were found in those boys with the symptoms listed above. The deficiency of essential fatty acids probably represents a metabolic disturbance. It may be compensated for by supplementation with flax seed oil, fish oils or evening primrose oil.
There is no single supplement that will meet the needs of all children. I often use organic flax seed oil, generally one teaspoon per day. My reasons for choosing flax oil are that most Americans are deprived of alpha-linolenic acid (the leading omega-3 essential fatty acid in the diet) because of food processing and food choices. Supplying a nutritional dose of alpha linolenic acid allows the child to overcome this deficiency in the safest fashion. If there is no improvement in behavior, concentration or dryness, I may replace flax oil with fish oil, generally supplying 300 to 400 milligrams of docosahexaenoic acid (DHA) per day. DHA is the omega-3 essential fatty acid with the highest concentration in brain. If hyperactivity or dryness intensifies with omega-3 supplementation, it may indicate the need for omega-6 supplements. The leading omega-6 essential fatty acid in the diet is linoleic acid. Although deficiency of linoleic acid is extremely rare, the Purdue group found low levels of its major metabolites in the blood of children with ADHD.
For those children who do not respond well to omega-3 essential fatty acid supplements, the most effective way to increase the levels of linoleic acid metabolites (omega-6 EFAs) is to supplement with evening primrose oil or borage oil, which supply the biologically active linoleic acid derivative gamma linolenic acid (GLA). Proper EFA supplementation will improve not only behavior but also dryness of the skin and hair and brittle nails.
(B) Does the child have stomachaches, headaches or muscle pains, or has difficulty sleeping and restless? These symptoms often indicate a deficiency of magnesium or calcium. Hyperactive children become magnesium deficient for two reasons. First, like most American children, they consume far too little magnesium in the food they eat. Second, the high adrenaline levels associated with hyperactivity cause them to excrete excessive amounts of magnesium in the urine, causing magnesium deficiency by depletion.
Observational studies in Germany and in France reveal a high frequency of symptomatic magnesium deficiency in hyperactive children, especially those with headaches or abdominal pain. In my clinical practice I have found magnesium supplementation to be especially useful for sleep disturbances in children with ADHD, although the effects on hyperactive behavior are minimal.
The usual dose is 100 milligrams per day for younger children and 200 milligrams for older children, taken at bedtime. If the child's diet is low in calcium, it may be necessary to add a calcium supplement, also taken at bedtime, generally 400 milligrams for younger children and 800 milligrams for older children. There is no evidence that calcium and magnesium interfere with each other's absorption or that a fixed ratio of calcium or magnesium must be administered to a child or on adult.
A possible side effect of magnesium supplementation is diarrhea, whereas a possible side effect of calcium supplementation is constipation.
(C) Has the child taken antibiotics more than once a year? Does he or she become more hyperactive after antibiotics? If so, an overgrowth of yeast in the intestines may be contributing to hyperactivity. Yeast is a potent allergen and also ferments sugar, producing chemicals which can be toxic to the nervous system. Yeast overgrowth can be countered by avoiding sweets and supplementing the diet with probiotics like Lactobacillus or Bifidobacteria. Anti-fungal medications may also be useful if yeast overgrowth is suspected.
Other nutritional supplements demonstrated to help children with ADHD in clinical trials are zinc and pycnogenol, an extract of the French maritime pine. The benefits of these supplements may not be obvious for several weeks.
B-complex vitamins sometimes help children with ADHD, but their effect can be paradoxical. Some children with ADHD become more hyperactive when taking B-vitamins. If a hyperactive child is taking a multivitamin or any B-vitamins, I generally recommend stopping them to see if behavior improves or worsens. It's all part of individualizing treatment.
Now I'd like to hear from you ... What are your thoughts on the rising rates of ADHD? Do you know of anyone helped by special diets or supplements? How have doctors helped?
Please let me know your thoughts by posting a comment below.
Best Health,
Leo Galland, MD
Leo Galland, MD is a board-certified internist, author and internationally recognized leader in integrated medicine. Dr. Galland is the founder of Pill Advised, a web application for learning about medications, supplements and food. Sign up for FREE to discover how your medications and vitamins interact. Watch his videos on YouTube and join the Pill Advised Facebook page.
REFERENCES
CDC REPORT
"Increasing Prevalence of Parent-Reported Attention-Deficit/Hyperactivity Disorder Among Children --- United States, 2003 and 2007 MMWR." November 12, 2010 / 59(44);1439-1443
RITALIN INCREASES TOBACCO CONSUMPTION
Rush CR, Higgins ST, Vansickel AR, et al. "Methylphenidate increases cigarette smoking."Psychopharmacology (Berl). 2005 Oct;181(4):781-9.
DIET
Egger J, Carter CM, Graham PJ et,al., "Controlled trial of oligoantigenic treatment in the hyper kinetic syndrome", Lancet 1985 volume 1 pp. 540-545.
Pelsser LM, Frankena K, Toorman J, et al.."A randomised controlled trial into the effects of food on ADHD." Eur Child Adolesc Psychiatry. 2009 Jan;18(1):12-9.
"National Institutes of Health consensus development conference statement: defined diets and childhood hyperactivity."Am J Clin Nutr. 1983 Jan;37(1):161-5.
FATTY ACIDS
Stevens L. J.,Zentall SS, Deck JL, et al, "Essential fatty acid metabolism in boys with attention deficit hyper activity disorder, American Journal of Clinical Nutrition", 1995, volume 62, pp. 761-768.
Stevens L, Zhang W, Peck L, et al. "EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviors." Lipids. 2003 Oct;38(10):1007-21.
Johnson M, Ostlund S, Fransson G, et al.. "Omega-3/omega-6 fatty acids for attention deficit hyperactivity disorder: a randomized placebo-controlled trial in children and adolescents." J Atten Disord. 2009 Mar;12(5):394-401.
Sinn N, Bryan J "Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD." J Dev Behav Pediatr. 2007 Apr;28(2):82-91
MAGNESIUM
Galland L., "Magnesium, stress and neuropsychiatric disorders", Magnesium and Trace Elements, 1991, volume 10, pp. 287-301.
Nogovitsina OR, Levitina EV. "Effect of MAGNE-B6 on the clinical and biochemical manifestations of the syndrome of attention deficit and hyperactivity in children." Eksp Klin Farmakol. 2006 Jan-Feb;69(1):74-7.
Starobrat-Hermelin B, Kozielec T."The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactivity disorder (ADHD). Positive response to magnesium oral loading test." Magnes Res. 1997 Jun;10(2):149-56.
ZINC
Lepping P, Huber M. "Role of zinc in the pathogenesis of attention-deficit hyperactivity disorder: implications for research and treatment."CNS Drugs. 2010 Sep 1;24(9):721-8
Bilici M, Yildirim F, Kandil S, et al. "Double-blind, placebo-controlled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder." Prog Neuropsychopharmacol Biol Psychiatry. 2004 Jan;28(1):181-90
PYCNOGENOL
TrebatickĂ¡ J, KopasovĂ¡ S, HradecnĂ¡ Z, et al."Treatment of ADHD with French maritime pine bark extract, Pycnogenol." Eur Child Adolesc Psychiatry. 2006 Sep;15(6):329-35.
This information is provided for general educational purposes only and is not intended to constitute (i) medical advice or counseling, (ii) the practice of medicine or the provision of health care diagnosis or treatment, (iii) or the creation of a physician--patient relationship. If you have or suspect that you have a medical problem, contact your doctor promptly.
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CDC - Attention Deficit Hyperactivity Disorder(ADHD) Homepage - NCBDDD
ADD and ADHD Center: Symptoms, Types, Causes, Tests, and Treatments
Attention-deficit/hyperactivity disorder (ADHD) - MayoClinic.com
AAP CHILDREN'S HEALTH TOPICS: ADHD
The Feingold Diet Program for ADHD
ADHD diet: Do food additives cause hyperactivity? - MayoClinic.com
A low-carb diet has really helped him. I don't think he has the skin issues anymore (he is in his twenties and live out-of-state). He works at a Whole Foods store and is strong proponent of dietary treatment for "ADHD." He wrote papers in college composition classes about the folly of pharmaceutical treatment for mood disorders.
Great article and spot on. Wish I could have read this 10 years ago and saved my beautiful son years of difficulty.
The comments here are fairly amusing. Yes, perhaps there is a food chemical cause. I wouldn't rule out the possibility that exposure to lead or other manmade chemicals could cause it. I personally am allergic to red and blue dyes in cosmetics, so I can only imagine the havoc they create once consumed in foods. I personally subsist on healthy, non-processed foods, and I am still a classic ADD case. I'm also an artist, a musician, knowlegable about countless topics, and if you haven't gathered - what I am saying is that I am pretty damned smart. My only reason for taking Adderall, frankly, is to function in a nearly strictly linear world that has little tolerance for non-lateral types.
Adderall works. Simply and beautifully. I took Ritalin years ago and it was a completely different experience. Too many side effects.
I would add one major component to the article, and to your procedure - a referral to a pediatric chiropractor. I say this not as a out-there theory, but as a pediatric certified DC myself who specializes in ADHD and NeuroDevelopmental Disorders.
All of the things you mentioned, along with other factors, lead these children to have overactive central nervous systems. The autonomic portion of this system is stuck in sympathetic (fightflight) overdrive, and the sequelae of that are the exact symptoms of ADHD and hyperactivity (along with sensory and other spectrum issues as well).
Chiropractic is the most effective care out there to restore balance and function to the ANS, getting that child out of the sustained fight/flight, allowing their system to calm and relax. This has many "side effects" such as... improved immune function, improved respiratory function, improved GI function, and more. The CNS controls all other systems.
Also, pediatric chiros are wellness doctors and work closely with nutrition, movement-based therapy, and stress reduction and management with the family to cover all bases.
It is clear you are an incredible doctor making a major impact. If you had a peds chiro to work with to cover the dysautonomia and dysponesis issues these kids have, your results would improve evne more!
unable to process sugar. All Diabetics do not have ADHD so sugar is not the cause.
Please share what you know about the links between low ferritin levels and ADHD. I became aware of this linkage when my daughter was diagnosed with Restless Leg Syndrome, which has been linked to dopamine activity and is treated with iron supplementation if ferritin levels are low (or the low side of normal). Similarly, ADHD has been found to be correlated with low ferritin levels.
also, I want to alert readers to two articles from the New York Times. One cites studies that demonstrate a powerful affect of reducing ADHD symptomatology by walking in "green space" and the other describes a study that demonstrated that food addatives cause ADHD symptomatology in neurotypical children.
http://well.blogs.nytimes.com/2008/10/17/a-dose-of-nature-for-attention-problems/
http://www.nytimes.com/2007/09/06/health/research/06hyper.html?_r=1&pagewanted=all
Starting a new project? Excruciating. Figuring out what needs to be done, the different steps needed, the right following of order? I make a lot of lists, number steps, redo the list. Once started I work like a bulldog, lose track of time, sometimes forgetting to eat, put in extra hours making sure everything gets done, so it tends to make up for the slow starting part. But I’m a bit of a perfectionist, having been told most of my life that I’m lazy or incapable, I have an internal slave driver that HAS TO PROVE THEM WRONG.
I’ve been told that medication will turn me into a zombie but it actually allows me to be a better version of myself. Previous to treatment I was angry and irritable. When I was younger I drank or used drugs to filter out all the static but when I stopped my world collapsed around me. I sank into a depression and withdrew from the world. Life was just too exhausting and I needed 10-12 hours of sleep a day. Not everyone with ADHD is hyper, high energy. Some kids outgrow ADHD and then some just lose the hyperactivity, but the majority grow into adults with ADHD.
As for the article, exercise and diet are more than very important. But I don't believe you can completely treat it with just exercise and diet. If this were the case i wouldn't be a disorganized social wreck.
The best treatment for people with ADD or ADHD is support. Being a very disorganized person, its nice to have people in your life that understand this. We are not disorganized on purpose we just work on a different time schedule than society. Our thoughts control our schedule.
People with ADHD or ADD are often stigmatized as being lazy, stupid, or crazy (get the book if you have been diagnosed with ADD/ADHD called 'You mean I'm not lazy, stupid, or crazy' by Kate Kelly). I've discovered that the people with ADD or ADHD are naturally very intelligent. As parents, guardians, or sufferers you should know this and express this because it helps. It took me awhile to understand that my difference is not my curse.
Its difficult for people without ADD/ADHD to understand our struggles but our struggles do exist and they are not a fictitious product of an overactive mind. Read the other testaments.
As a parent who managed to keep a few hairs on my head (after going through the process of "what the heck is going on with my child" to seeking medical advise, educator advise, nutritional advise ... and life advise) there are a few suggestions i can make:
1. your child's primary care physician cannot effectively diagnose ADD/ADHD. a good physician will do blood work to rule out other issues and refer you to a Neurologist. And even then - the Neurologist will refer you to a Neuropsychologist who will conduct a battery of tests. (beware - your insurance company will do everything they can to get out of paying for this testing)
2. sugar does not cause ADD/ADHD. but staying away from processed sugars, food dyes & eating whole grains REALLY helps. in our family, we limit glutens and wheat products.
3. many kids with ADD/ADHD are lactose intolerant -- so pay attention to this. it will help.
4. ADD/ADHD is a neurological disorder -- not a "behavioral problem".
5. the family making ADD/ADHD part of their lives really helps maintain sanity - and eventually, you learn to laugh along & discover the awesome-ness of it all : )
6. medications can help -- you just have to have a good physician who will work with your child & know that the right type of meds have to work with the right type of ADD/ADHD (check out Dr. Daniel Amen)
7. good quality supplements help -- especially fish oils & multi vitamins
8. expose your children to lots of exercise & extra curricular activities (less TV & electronics). What child wouldn't benefit from this?
9. it is not uncommon for, kids with ADD/ADHD to have related diagnoses (i.e. dyslexia, learning disabilities, anxiety disorder, etc.)
10. be your child's advocate -- especially @ school.
11. get to know your child & when they know they are unconditionally loved, valued & understood, amazing blessings will be in store : )
i don't know how many times i have heard parents say: oh ... it is not ADD/ADHD - the doctor gave some medication and it definitely did not work; so I know it is not ADD. and all i can think of is: there are so many approaches, medications ... and variations of ADD/ADHD -- it is so much more than medicating a child
i don't have ADD .. but have been on some good quality Omega 3 fish oils, supplements ... and green tea-type beverages ... there are some fantastic benefits such as good skin, good heart health, better balance of hormones, etc.
now ... if i can convince parents that they ought delete the idea of buying soda ... and it should be something that's a couple of times a year treat ... right along w/ processed - refined sugar laced things and high fructose corn syrup ...
“Results show that 1-month Pycnogenol administration caused a significant reduction of hyperactivity, improves attention and visual-motoric coordination and concentration of children with ADHD. - Dr. Peter Rohdewald of the Institute of Pharmaceutical Chemistry, University of Munster.
A chemical used in nonstick cookware increases children's risk of developing attention deficit hyperactivity disorder (ADHD), according to a study conducted by researchers from Boston and Harvard Universities and published in the journal Environmental Health Perspectives.
The findings were previously presented at the annual meeting of the International Society of Environmental Epidemiology in Ireland.
Researchers took blood samples from children and compared their levels of a chemical known as C8 with their risk of being diagnosed with ADHD. They found that every 1 part per billion increase in C8 concentration in the blood corresponded to a 12 percent increase in the risk of ADHD.
C8, also known as perfluorooctanoic acid (PFOA) is used to manufacture nonstick coatings, food packaging and stain- and water-resistant fabrics. It is in the family known as perfluorinated chemicals (PFCs).
PFCs persist indefinitely in the environment and have been shown to build up in animal tissue; C8 and other PFCs have been found in the blood of people around the world.
Increasing evidence suggests that even very low levels of C8 -- those commonly found in people worldwide -- have the potential to produce health problems including endocrine (hormone) disruption, cancer, liver damage, immune problems, developmental damage, birth defects and high cholesterol.