© Tracy Ware, MD
© Tracy Ware, MD
Three decades of studies on
artificial food dyes and ADHD have
established that:
1.
Existing ADHD can be aggravated by
artificial food dyes.
Prescrire Int. 2009 Oct;18(103):215
Center for Science in the Public Interest
Photo credit: Moira Donahue
2.
Elimination diets can significantly
improve symptoms in a majority of
children with ADHD.
Ann Allergy. 1994 May;72(5):462-8
Ned Tijdschr Geneeskd. 2002 Dec 28;146(52):2543-7
© Tracy Ware, MD
Recent studies have extended the findings
to children in the general community.
Lancet. 2007 Nov 3;370(9598):1560-7
Am J Psychiatry. 2010 Sep;167(9):1108-15
Community volunteers 300 children
– 3 year olds and 8/9 year olds
© Tracy Ware, MD
Interviews
Parents ADHD scale
Teachers ADHD scale
Classroom observation
Connors CPT
1) Wash out week
2) Alternate dye and no dye weeks
© Tracy Ware, MD
MIX A: sunset yellow (FD&C Yellow 6), carmoisine, tartrazine (FD&C Yellow 5),
ponceau 4R (banned US), sodium benzoate
MIX B: sunset yellow (FD&C Yellow 6), carmoisine, quinoline yellow,
allura red (FD&C Red 40 ) sodium benzoate
“Dose” of dyes was approximately 10%
of the average daily food dye
consumption in the US.
National Academy of Sciences 1977
red 40 natural flavor blue 2 turmeric
color yellow 6 annatto color blue 1
© Tracy Ware, MD
Both age groups showed a
significant increase in ADHD
symptoms when exposed to the
food dyes
Lancet. 2007 Nov 3;370(9598):1560-7
=
Center for Science in the Public Interest
Photo credit: Moira Donahue
© Tracy Ware, MD
FOODS: Apple Jacks, Jello pudding, orange squash, orange jelly, marzipan,
Swiss roll, Irn-Bru, apricot jam, citrus marmalade, lemon curd, sweets, hot
chocolate mix and packet soups, trifle mix, breadcrumbs and cheese sauce
mix and soft drinks, astro peach yogurt (potentially others), fortune cookies,
some red sauces, certain pound cakes, snack chips and other yellow, orange,
and red food products. Sunset Yellow is often used in conjunction with E123,
Amaranth, in order to produce a brown coloring in both chocolates and
caramel.
MEDICATIONS: DayQuil (in high concentrations), some extra strength Tylenol
PERSONAL CARE PRODUCTS: Lipstick (688) Makeup (General) (342) Lip Gloss
(206) Hair Care (General) (124) Shampoo (91) Moisturizer (76) Blush (74) Body
Wash & Cleanser (60) Conditioner (53) Bath & Shower (General) (41)
© Tracy Ware, MD
- Wikipedia
2010 the Center for Science in the Public Interest called for
the FDA to ban the implicated food dyes.
March 31st, 2011 - Response from FDA:
Insufficient Evidence
The committee will make “no recommendation to ban or
regulate dye additives …more research is needed”.
© Tracy Ware, MD
The Next
Question:
Which children react?
© Tracy Ware, MD
Study tested for:
ADHD associated
dopamine genetic variants
Two genetic variants for
impaired histamine
metabolism
Which genes tracked with the reaction????
© Tracy Ware, MD
It was the
HISTAMINE!!!!
Histamine is the chemical released when you
have an allergic reaction. That is why you take
“anti-histamines” like Benadryl or Claritin
© Tracy Ware, MD
WAIT – when there is food
intolerance, histamine release
happens in the GI tract, not the brain.
True, but when the body cannot clear the histamine from the
blood, it floods the brain and causes ADHD symptoms.
There are at least three types of histamine receptors in the brain:
H1, H2, H3.
H3 receptors are the ones that cause ADHD symptoms when
there is too much histamine.
© Tracy Ware, MD
Interesting Questions:
What about all the other events that
trigger histamine release?
What about the people who have reactions to the
foods, but can clear most of the histamine?
Could adult onset allergies be the reason for
adult onset ADHD?
Can you treat some ADHD by OTC antihistamines?
© Tracy Ware, MD
So what does histamine do in the brain anyway????
Histamine (H3) receptors are EVERYWHERE !!!
Histamine (H3) controls:
Sleep and wakefulness
Learning and memory
Anxiety
Locomotion
Feeding and drinking
Hormone regulation
AND Dopamine/norepinephrine
Future Medical Engineering based on Bionanotechnology 21st century COE Program.
© Tracy Ware, MD
Histamine receptors
(H3) control:
Sleep and wakefulness
Learning and memory
Anxiety
Locomotion
Feeding and drinking
Hormone regulation
Future Medical Engineering based on Bionanotechnology 21st century COE Program.
AND Dopamine/norepinephrine
© Tracy Ware, MD
Wait… Isn’t histamine also in some foods???
© Tracy Ware, MD
YES!!!!
© Tracy Ware, MD
Foods that are high in histamine
Fish, Mackerel, Herring, Sardine, Tuna, Cheese, Gouda, Camembert,
Cheddar, Emmental, Swiss, Parmesan, Fermented sausage, Salami,
Fermented ham, Sauerkraut, Spinach, Eggplant, Tomato ketchup, Red wine
vinegar, Alcohol, White wine, Red wine, Top-fermented beer, Bottomfermented beer, Champagne, Citrus fruit, Fish Additives, Papaya, Crustaceans,
Liquorice, Strawberries, Pork Spices, Pineapple, Egg white, Nuts, Peanuts,
Tomatoes, Spinach, Chocolate
© Tracy Ware, MD
© Tracy Ware, MD
A Compound Herbal Preparation (CHP) in the Treatment of
Children With ADHD: A Randomized Controlled Trial
- J Atten Disord. 2010 Nov;14(3):281-91. Epub 2010 Mar 12
Widely reported as proof herbs can treat ADHD
Maybe, but this study does not answer the question
It is an infomercial masquerading as research
© Tracy Ware, MD
Research article did not report ANY direct
measures of ADHD.
According to the company website, they collected the
data. Why leave data out of the report?
Small improvement in TOVA (a continuous
performance test used to measure attention).
(Omega-3’s improve TOVA more than CHP!)
© Tracy Ware, MD
Authors also claim product is “safe”,
“well tolerated” and that the ingredients
are approved by the FDA.
© Tracy Ware, MD
Actually the most potentially toxic
supplement I have ever seen:
•
•
•
•
•
•
•
autoimmune disorders
elevated blood glucose
elevated cholesterol
viral infection
brain cancer
miscarriage
thyrotoxicosis or impaired thyroid
•
•
•
•
•
•
liver damage
decreased neuroplasticity (learning)
two ingredients are potent chemotherapy agents.
increased risk from anaesthesia
weight gain
shown to be cytotoxic and impair DNA in fish.
“Natural” does NOT mean safe!!!!!
© Tracy Ware, MD
By Federal law,
supplements/herbal products
are food NOT medication
© Tracy Ware, MD
FDA does not
Approve supplements or herbs
Insure they are safe before being sold
Require the label list known side effects
or dangerous drug interactions
© Tracy Ware, MD
“FDA is responsible for taking
action against any unsafe
dietary supplement product
after it reaches the market.”
© Tracy Ware, MD
Authors –
M. Katz, A. Adar Levine, H. Kol-Degani and L. Kav-Venaki
“..no conflict of interest”
Look behind the curtain!
© Tracy Ware, MD
Compound Herbal Preparation is a proprietary product sold as
“Nurture & Clarity” by The Tree of Healing Clinic
“The Tree of Healing clinic was “established and is managed by”
Hadassa Kol-Degani & Liora Tanury Kav-Venaki
© Tracy Ware, MD
Stimulant Research Update
Short-term Effects
Benefits
Enhance classroom manageability
Increase attention and academic productivity
Impair
cognitive flexibility
creativity
problem solving
Transitioning
Executive function skills?
© Tracy Ware, MD
Dosing Stimulants: A Balancing Act
Productivity
Increasing
effect of
stimulant
Increasing dose of stimulant
© Tracy Ware, MD
Dosing Stimulants: A Balancing Act
Productivity
Transitioning (creativity)
Increasing
effect of
stimulant
Increasing dose of stimulant
© Tracy Ware, MD
Dosing Stimulants: A Balancing Act
Productivity
Transitioning (creativity)
Side effects
Increasing
effect of
stimulant
Increasing dose of stimulant
© Tracy Ware, MD
Dosing Stimulants: A Balancing Act
Productivity
Transitioning (creativity)
Side effects
Increasing
effect of
stimulant
Agitated, can’t sit still
Poor focus in class
Increasing dose of stimulant
© Tracy Ware, MD
Dosing Stimulants: A Balancing Act
Productivity
Transitioning (creativity)
Side effects
Increasing
effect of
stimulant
Agitated, can’t sit still
Poor focus in class
Target dose range
Increasing dose of stimulant
© Tracy Ware, MD
Up-slope:
Increased adrenaline
Increasing
effect of
stimulant
Connections between the cells open up
Concentration and productivity improve
Increasing dose of stimulant
Down-slope:
Safety valve to prevent seizures
Connections between the cells close down
Complete shut down = ADHD brain freeze
© Tracy Ware, MD
Stimulant Research Update
Long-term stimulants are of very limited benefit
What stimulants do not do…
• normalize the ability to learn and apply
knowledge.
• prevent academic underachievement and
poor educational outcomes
• improve full-scale IQ
• improve reading and arithmetic
achievement tests,
• decrease remedial academic services,
• decrease special education classes,
decrease probability of repeating a grade of
being expelled,
© Tracy Ware, MD
•suspended or repeat a grade, compared with
controls.
•By the time they reach adolescence,
•fail more grades
•have lower report card scores,
•lower class rankings
•worse scores on standardized achievement
tests
• more years to complete high school
•lower rates of college attendance and
graduation.
•
Special Update Amphetamines
Neurotoxicity (previous talk)
Epidemiology studies – Possible increased
risk for Parkinson’s Disease
Neurotoxicology. 2006 Dec;27(6):1003-6. Epub 2006 Mar 28.
Amphetamine exposure is elevated in Parkinson's disease.
Garwood ER, Bekele W, McCulloch CE, Christine CW.
Mov Disord. 2010 Jan 30;25(2):228-31.
Parkinsonism in patients with a history of amphetamine exposure.
Christine CW, Garwood ER, Schrock LE, Austin DE, McCulloch CE.
© Tracy Ware, MD
Contact Information
Tracy A. Ware, MD
Chapel Hill Psychiatric Associates, PA
610 Jones Ferry Road Ste 208
Carrboro, NC 27510
VM: 919-338-2940
twareMD@chapelhillpa.com
© Tracy Ware, MD