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A Holistic Approach to overcoming inattention and restlessness in ADHD

According to the American Psychiatric Association the prevalence of Attention deficit hyperactivity disorder (ADHD) has been progressively increasing in teenagers as well as adults. The prevalence in adults has increased more than 3 fold from 2002-2007 with the largest increase in 18-24 years age group.

Those diagnosed with ADHD suffer from poor concentration, difficulty focusing and excessive distractibility. This leads to difficulty initiating and completing tasks as well as making decisions and poor organizational skills. The other aspect of ADHD is hyperactivity and restlessness which leads to impulsive behavior, mood swings and anger outbursts. In addition these individuals are 6 times more likely to have other mental health problem such as depression and anxiety. The symptoms often begin early in life and continue in adulthood. Those suffering from ADHD do not merely experience emotional distress but also have significant social impairment leading to difficulty in maintaining relationships with peers and family members. Individuals with ADHD suffer from low esteem, chronic stress and sense of underachievement.

Those who are diagnosed are often started on lifelong psychostimulant medications that have been linked to many side effects. In addition, these individuals’ are also prescribed antidepressants and anxiety medications. There is research that shows that ADHD is linked to our diet as well as our environment and nutritional deficiencies. A better understanding and assessment of an individual’s exposures throughout the life, lifestyle, hormonal imbalances and nutritional status can provide an alternative, natural, safe and effective way to overcome ADHD. Below are some of the main factors that can contribute towards development and exacerbation of symptoms of ADHD.

ADHD and diet

Researchers at Harvard and Columbia University found that artificial food colorings and preservatives that are commonly present in candies, chocolates, cereals, cookies, junk foods, fruit juices or sodas can explain about 10% difference in the behaviors of those effected with ADHD. A metaanalysis of 15 double blind placebo controlled trials (A double blind placebo controlled trial is considered the best research evidence) found that eliminating these from the diet would be at least one-third to one half as effective as treatment with a psychostimulant.

In addition to the food preservatives and colorings, there may be other foods that can affect an individual’s brain and behavior such as amount of sugar consumed as well as gluten sensitivity. It is important that the assessment is individualized to understand the unique genetic make-up as well as the physical, emotional, cultural, social and spiritual context which led to the development of this disorder.

ADHD and microbiome

There is a lot of research that indicates a very close relationship between the bacteria that reside in our guts (the microbiome) and its impact on our brain. These bacteria play a role in brain development as well as affect our mood and our behavior. It is critical to understand and assess the microbiome in order to manage any disorder that effects human behavior.

ADHD and Hormones

Children and adults with ADHD have been found to have resistance to thyroid hormone. This is an important finding because it provides us an understanding of the root cause of ADHD and provides an opportunity to treat the underlying problem rather than giving medications that alter the brain function to control the symptoms with potential long term side effects. In addition, abnormal thyroid function can affect multiple systems in the body leading to many other health issues.

Another important abnormality in these individuals is the abnormal diurnal rhythm of the cortisol hormone. This reflects an abnormal function of the adrenal glands. This indicates that the underlying cause of symptoms of emotional lability and hyperactivity may be a result of this hormonal dysfunction. Correcting the underlying problem can improve symptoms and avoid the need for medications.

ADHD and heavy metals

Several researchers have reported connection between exposure to heavy metals such as Mercury and the risk of developing ADHD as well as other neurodevelopmental disorders such as Autism. An interesting finding in these studies was elevated levels of metals such as lead in the blood and urine of those diagnosed with ADHD compared to those without the disorder. In addition to impairment of the nervous system, these metals can also accumulate in other organs and lead to toxic insults resulting in heart disease, Diabetes, blood disorders and cancer. These metals can produce toxic effects even at a very low level of exposure and have the potential of producing changes in the DNA.

ADHD and Nutritional deficiencies

Individuals suffering from ADHD have been found to have deficiencies of many different nutrients such as Magnesium, ferritin, B vitamins, Omega 3 fatty acids. These nutrients play an important role in the function of the brain cells (Neurons) as well are important in carrying out the metabolic processes required for healing, nourishing and proper functioning of the organs and systems. Repleting the nutrients allows a decrease in the dose of the psychostimulant medication and helps improve the functioning of the individual.

Holistic Approach to ADHD

An integrative holistic approach to ADHD requires a thorough assessment of the following areas

Diet and nutritional assessment
Hormonal assessment
Assessment of the microbiome and the gut
Assessment of the environmental exposures
Assessment to identify underlying infections and inflammation
Assessment of the emotional, social and spiritual context of an individual

This will provide a comprehensive approach to identification of potential root causes. This needs to be followed by an individualized program that engages and empowers individuals and families to treat the root causes and improve the symptoms. In addition, this approach can help an individual avoid psychostimulants or taper them off. It will also help prevention of the long term consequences of the underlying hormonal, environmental toxicities and nutritional deficiencies leading to a better quality of life.

Integrative Program for Mental Health

References

http://www.cdc.gov/ncbddd/adhd/data.html
Curr Med Res Opin. 2011;27 Suppl 2:5-11. doi: 10.1185/03007995.2011.603302. Adult ADHD: prevalence of diagnosis in a US population with employer health insurance. Montejano L1, Sasané R, Hodgkins P, Russo L, Huse D.
Lancet. 2007 Nov 3;370(9598):1560-7. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. McCann D1, Barrett A, Cooper A, Crumpler D, Dalen L, Grimshaw K, Kitchin E, Lok K, Porteous L, Prince E, Sonuga-Barke E, Warner JO, Stevenson J.
Schab DW, et al. “Do Artificial Food Colors Promote Hyperactivity in Children with Hyperactive Syndromes? A Meta-Analysis of Double-Blind Placebo-Controlled Trials,” Journal of Developmental and Behavioral Pediatrics (Dec. 2004): Vol. 25, No. 6, pp. 423–34.
Curr Opin Psychiatry. 2015 Jan; 28(1):1-6. doi: 10.1097/YCO.0000000000000117. The gut microbiome and diet in psychiatry: focus on depression. Dash S1, Clarke G, Berk M, Jacka FN.
N Engl J Med. 1993 Apr 8;328(14):997-1001. Attention deficit-hyperactivity disorder in people with generalized resistance to thyroid hormone. Hauser P1, Zametkin AJ, Martinez P, Vitiello B, Matochik JA, Mixson AJ, Weintraub BD.
Psychoneuroendocrinology. 2003 Apr;28(3):304-16. Thyroid function tests and neurocognitive functioning in children referred for attention deficit/hyperactivity disorder. Stein MA1, Weiss RE.
J Pediatr. 1993 Oct; 123(4):539-45. Attention-deficit hyperactivity disorder and thyroid function. Weiss RE1, Stein MA, Trommer B, Refetoff S.
Brain Res. 2011 Jan 12; 1368:159-62. doi: 10.1016/j.brainres.2010.10.045. Epub 2010 Nov 12. The function of hypothalamus-pituitary-adrenal axis in children with ADHD. Ma L, Chen YH, Chen H, Liu YY, Wang YX.
J Autism Dev Disord. 1993 Mar; 23(1):59-65. Hypothalamic-pituitary-adrenal axis function in children with attention-deficit hyperactivity disorder. Kaneko M1, Hoshino Y, Hashimoto S, Okano T, Kumashiro H.
J Trop Pediatr. 2011 Dec; 57(6):457-60. doi: 10.1093/tropej/fmq121. Epub 2011 Feb 6. Attention deficit hyperactivity disorder and environmental toxic metal exposure in the United Arab Emirates. Yousef S, Adem A, Zoubeidi T, Kosanovic M, Mabrouk AA, Eapen V.
Rev Med Inst Mex Seguro Soc. 2014 Jan-Feb; 52(1):20-7. [Blood and urine lead levels in children with attention deficit hyperactivity disorder]. Sánchez-Villegas Mdel C1, Cortés-Vargas A, Hidalgo-Luna RG, Alam-Escamilla DA, Vargas-García VM, Loría-Castellanos J.
Neurotoxicology. 2014 Sep; 44:121-31. doi: 10.1016/j.neuro.2014.06.007. Epub 2014 Jun 19. A meta-analysis of the evidence on the impact of prenatal and early infancy exposures to mercury on autism andattention deficit/hyperactivity disorder in the childhood. Yoshimasu K, Kiyohara C, Takemura S, Nakai K.
NIH. Heavy Metals Toxicity and the Environment Paul B Tchounwou , Clement G Yedjou, Anita K Patlolla, and Dwayne J Sutton NIH-RCMI Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Box 18750, Jackson, MS 39217, USA
J Child Adolesc Psychopharmacol. 2000 summer; 10(2):111 Does zinc moderate essential fatty acid and amphetamine treatment of attention-deficit/hyperactivity disorder? Arnold LE, Pinkham SM, Votolato N.
J Child Adolesc Psychopharmacol. 2011 Feb; 21(1):1-19. doi: 10.1089/cap.2010.0073. Zinc for attention-deficit/hyperactivity disorder: placebo-controlled double-blind pilot trial alone and combined with amphetamine. Arnold LE1, Disilvestro RA, Bozzolo D, Bozzolo H, Crowl L, Fernandez S, Ramadan Y, Thompson S, Mo X, Abdel-Rasoul M, Joseph E.
J Child Adolesc Psychopharmacol. 2010 Dec; 20(6):495-502. doi: 10.1089/cap.2010.0053. Serum ferritin and amphetamine response in youth with attention-deficit/hyperactivity disorder. Calarge C1, Farmer C, DiSilvestro R, Arnold LE.
FASEB J. 2015 Jun; 29(6):2207-22. doi: 10.1096/fj.14-268342. Epub 2015 Feb 24. Vitamin D and the omega-3 fatty acids control serotonin synthesis and action, part 2: relevance for ADHD, bipolar disorder, schizophrenia, and impulsive behavior. Patrick RP, Ames BN.
J Atten Disord. 2014 Jan 24. [Epub ahead of print]. Efficacy and Safety of Omega-3/6 Fatty Acids, Methylphenidate, and a Combined Treatment in Children with ADHD. Barragán E, Breuer D, Döpfner M.

A Holistic Approach to overcoming inattention and restlessness in ADHD

Diet and nutritional assessment

Hormonal assessment

Assessment of the microbiome and the gut

Assessment of the environmental exposures

Assessment to identify underlying infections and inflammation

Assessment of the emotional, social and spiritual context of an individual

http://www.cdc.gov/ncbddd/adhd/data.html

Curr Med Res Opin. 2011;27 Suppl 2:5-11. doi: 10.1185/03007995.2011.603302. Adult ADHD: prevalence of diagnosis in a US population with employer health insurance. Montejano L1, Sasané R, Hodgkins P, Russo L, Huse D.

Schab DW, et al. “Do Artificial Food Colors Promote Hyperactivity in Children with Hyperactive Syndromes? A Meta-Analysis of Double-Blind Placebo-Controlled Trials,” Journal of Developmental and Behavioral Pediatrics (Dec. 2004): Vol. 25, No. 6, pp. 423–34.

Curr Opin Psychiatry. 2015 Jan; 28(1):1-6. doi: 10.1097/YCO.0000000000000117. The gut microbiome and diet in psychiatry: focus on depression. Dash S1, Clarke G, Berk M, Jacka FN.

N Engl J Med. 1993 Apr 8;328(14):997-1001. Attention deficit-hyperactivity disorder in people with generalized resistance to thyroid hormone. Hauser P1, Zametkin AJ, Martinez P, Vitiello B, Matochik JA, Mixson AJ, Weintraub BD.

Psychoneuroendocrinology. 2003 Apr;28(3):304-16. Thyroid function tests and neurocognitive functioning in children referred for attention deficit/hyperactivity disorder. Stein MA1, Weiss RE.

J Pediatr. 1993 Oct; 123(4):539-45. Attention-deficit hyperactivity disorder and thyroid function. Weiss RE1, Stein MA, Trommer B, Refetoff S.

Brain Res. 2011 Jan 12; 1368:159-62. doi: 10.1016/j.brainres.2010.10.045. Epub 2010 Nov 12. The function of hypothalamus-pituitary-adrenal axis in children with ADHD. Ma L, Chen YH, Chen H, Liu YY, Wang YX.

J Autism Dev Disord. 1993 Mar; 23(1):59-65. Hypothalamic-pituitary-adrenal axis function in children with attention-deficit hyperactivity disorder. Kaneko M1, Hoshino Y, Hashimoto S, Okano T, Kumashiro H.

J Trop Pediatr. 2011 Dec; 57(6):457-60. doi: 10.1093/tropej/fmq121. Epub 2011 Feb 6. Attention deficit hyperactivity disorder and environmental toxic metal exposure in the United Arab Emirates. Yousef S, Adem A, Zoubeidi T, Kosanovic M, Mabrouk AA, Eapen V.

Rev Med Inst Mex Seguro Soc. 2014 Jan-Feb; 52(1):20-7. [Blood and urine lead levels in children with attention deficit hyperactivity disorder]. Sánchez-Villegas Mdel C1, Cortés-Vargas A, Hidalgo-Luna RG, Alam-Escamilla DA, Vargas-García VM, Loría-Castellanos J.

NIH. Heavy Metals Toxicity and the Environment Paul B Tchounwou , Clement G Yedjou, Anita K Patlolla, and Dwayne J Sutton NIH-RCMI Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Box 18750, Jackson, MS 39217, USA

J Child Adolesc Psychopharmacol. 2000 summer; 10(2):111 Does zinc moderate essential fatty acid and amphetamine treatment of attention-deficit/hyperactivity disorder? Arnold LE, Pinkham SM, Votolato N.

J Child Adolesc Psychopharmacol. 2010 Dec; 20(6):495-502. doi: 10.1089/cap.2010.0053. Serum ferritin and amphetamine response in youth with attention-deficit/hyperactivity disorder. Calarge C1, Farmer C, DiSilvestro R, Arnold LE.

FASEB J. 2015 Jun; 29(6):2207-22. doi: 10.1096/fj.14-268342. Epub 2015 Feb 24. Vitamin D and the omega-3 fatty acids control serotonin synthesis and action, part 2: relevance for ADHD, bipolar disorder, schizophrenia, and impulsive behavior. Patrick RP, Ames BN.

J Atten Disord. 2014 Jan 24. [Epub ahead of print]. Efficacy and Safety of Omega-3/6 Fatty Acids, Methylphenidate, and a Combined Treatment in Children with ADHD. Barragán E, Breuer D, Döpfner M.