June 2001
Attention Deficit Hyperactivity Disorder – The need for
a natural solution
Introduction
Imagine living in a fast-moving kaleidoscope, where sounds, images, and thoughts are
constantly shifting because all your senses are heightened. Your world seems too bright, too
loud, too abrasive and too rapidly changing for comfort. You find it difficult to filter out normal
background “noise” and find it difficult to concentrate on a task. For many people, this is what
it is like to have ADHD.
Attention Deficit Hyperactivity Disorder (ADHD) previously known as hyperkinesis is the most
common behavioural disorder in children.(1) It is estimated to affect 3 to 5 percent of schoolage children.(1) Frequently the symptoms of ADHD are commingled with learning problems,
oppositional conduct, anxiety and depression.
Symptoms and Extent of the ADHD problem
ADHD is a diagnosis applied to children and adults who consistently display certain
characteristic behaviours over a period of time. The most common behaviours fall into three
categories:



Inattention
Hyperactivity
Impulsivity
ADHD, according to the “Diagnostic and Statistical Manual (DSM-IV), must appear before
seven years of age, persist for at least six months and appear in the school environment as
well as the home.”(2)
Between 30-40% of ADHD subjects have learning disabilities.(3,4) Other neurobiological
difficulties associated with ADHD include Tourette’s disorder, anger control problems
(oppositional defiant disorder), anxiety and depression.(5,6)
Biederman studied a large population of ADHD children and found that more than half had
depression, anxiety, and conduct disorder.(6)
Current Medical Management – The Ritalin controversy
The first report of stimulant use to treat ADHD was in 1937.(7) The action of methylphenidate
(Ritalin) is virtually identical to cocaine. It acts on the CNS with a dopamine-agonistic effect
that is slower in onset, but mechanistically almost identical to cocaine and amphetamines. (8,9)
Scarnati lists more than 100 adverse reactions to methylphenidate. Contraindications as
stated in the MIMS include anxiety, tension, agitation, tics, Tourette’s syndrome,
hyperthyroidism and arrhythmias.(10)
The adverse reactions related to methylphenidate use include:
System
Central Nervous System
Reactions
Nervousness, insomnia, anorexia, headaches,
drowsiness, dizziness, depressed mood,
irritability, dyskinesia, blurring of vision,
dependence, tolerance.
Gastrointestinal
Abdominal pain, nausea, vomiting, dry mouth.
Cardiovascular
Tachycardia, palpitations, arrhythmias,
changes in BP and heart rate (usually an
increase).
Rash, pruritus, urticaria, fever, arthralgia,
alopecia.(10)
Dermatological and/or hypersensitivity
reactions
When methylphenidate is used with antidepressants (such as tricyclics and SSRI’s) seizures,
hypertension, hypothermia and convulsions can ensue.
As blood levels of the methylphenidate decrease over time, irritability can manifest as a
“rebound” type of withdrawal symptom. The frequent practice of maintaining ADHD patients
on methylphenidate over many years increases the potential for its abuse. In fact, it is fast
becoming a “street drug” in the US. In 1991 US emergency rooms reported less than 25
Ritalin overdoses. By 1995, this number was up to 400 cases for children aged 10-14
years.(11)
In 1994, US Government researchers reported that Ritalin caused liver cancer in male
mice.(12) The carcinogenic doses were equivalent to just 2½ times higher than the highest
human prescribed dose. The National Toxicology Program concluded methylphenidate is a
“possible human carcinogen”.
This revelation about methylphenidate, plus the major adverse effects, provides the clear
conclusion that it is imperative that alternative modalities be implemented for the
management of ADHD.
ADHD Etiology
ADHD is far from homogeneous, with many likely contributory factors. Some of these
etiological factors generate symptomatologies that closely resemble ADHD. Among these are
food sensitivities and intolerances, sensitivities to food additives, nutrient deficiencies, heavy
metal toxicity and toxic pollutant burden.
Underactivity of the brain linked to ADHD
Initial evidence of the brain being under stimulated in ADHD patients, was first considered
with the use of advanced electroencephalograms (EEG or brainwave studies). Lubar
demonstrated that when ADHD children performed a concentration task there was an
increased amount of slow brain wave activity in their frontal lobes, instead of the usual
increase in fast brain wave activity that was seen in the majority of the control group. (13)
In 1990 further research supported the notion that most ADHD people at rest, have normal
activity in their brain. However, when they perform a concentration task, they experience
decreased activity in the prefrontal cortex rather than the expected increased activity that is
seen in a normal control group.
Research using SPECT imaging (single photon emission computed tomography) which
measures cerebral blood flow and metabolic activity patterns, hypothesised and correlated 5
clinical subtypes of ADHD.
Sub-Type
Imaging of brain
ADHD
Combined type
Decreased activity in the
basal ganglia and
prefrontal cortex during
a concentration task
Imaging shows
decreased activity in the
basal ganglia and
dorsal lateral prefrontal
cortex during a
concentration task
Increased activity in the
anterior cingulate gyrus
and decreased prefrontal
cortex activity
Inattention and
hyperactivity-impulsivity
Tyrosine – to increase
PEA (phenylethylamine)
Inattention, chronic
boredom, decreased
motivation, internal
preoccupation and low
energy
Tyrosine
Cognitive inflexibility,
difficulty with transitions,
excessive worrying,
argumentative behaviour
Cingulate hyperactivity
appears to be due to
relative deficiency of
serotonin.
Decreased or increased
activity in the temporal
lobes with decreased
prefrontal cortex activity
Inattention and/or
hyperactivity and mood
instability, aggression,
mild paranoia, anxiety,
atypical headaches or
abdominal pain, learning
problems
Phosphatidyl Serine – to
improve memory problems
Negativity, depression,
sleep problems, low
energy, low self esteem,
social isolation
dl- Phenylalanine,
Tyrosine, SAME - help
limbic hyperactivity
ADHD primarily
inattentive subtype
Overfocused ADD
Temporal lobe ADD
Limbic ADD
Increased central limbic
system activity and
decreased prefrontal
cortex activity
Symptoms
Nutrients
Gingko biloba
Vitamin E – improves
memory and muscle
movement disorders
From further neurobiological studies a consensus is emerging that motor and attentional
functions associated with the frontal cortex, are adversely affected in ADHD. These areas of
the brain are predominantly dopaminergic, and hypofunction of dopamine pathways is a
consistent feature of the disorder.(13,14,15)
The Serotonin Connection to ADHD
In 1999, researchers at the Howard Hughes Medical Institute discovered that Ritalin and other
stimulants exert their paradoxical calming effects by boosting serotonin levels in the brain.
Elevating serotonin appears to restore the delicate balance between dopamine and serotonin
and reduces hyperactivity.(16)
Previously it was thought that the
calming action of Ritalin worked
through the neurotransmitter
dopamine. Specifically, researchers
believed that Ritalin and other
stimulants interacted with the
dopamine transporter protein (DAT).
After a nerve impulse moves from one
neuron to another, DAT removes
residual dopamine from the synaptic
cleft, and repackages it for future use.
However, Caron’s study found that if
DAT was removed then the calming
effect of Ritalin still occurred.
From these results it was then suspected that dopamine wasn’t the only key to understanding
ADHD. The studies suggested that rather than acting directly on dopamine, the stimulants
create a calming effect by increasing serotonin levels. The study concluded that the proper
balance between dopamine and serotonin was the key, and that hyperactivity may develop
when the relationship between dopamine and serotonin is out of balance.(17)
Another key amino acid is tyrosine, which assists the body cope physiologically with stress by
building the body’s store of adrenaline. Chronic stress increases the need for tyrosine and
often results in an extreme reduction of brain tyrosine levels.
Tyrosine with vitamin B6, zinc and magnesium helps regulate blood pressure and elevate
mood by enhancing the synthesis of noradrenalin in the brain.
Food Allergies, Gut Dysfunction and Gastrointestinal Parasites
Food sensitivities and food allergies provoke hyperactivity through partially digested food
(exorphins) entering the blood stream and scrambling the neuronal communication system.
In eight out of nine studies 86% of hyperactive children had elevated eosinophils indicative of
allergy or parasitic infection.(18) Data from two double blind studies indicated that 73-76% of
ADHD children responded favourably to food elimination diets. Maintenance on low-antigen
diets raised the success rate to 82%.(19)
One study found significant quantities of bacterial pathogens, yeast organisms and protozoan
parasites were in a high proportion of children with ADHD. These findings are quite
suggestive that these children suffered from impairment of gut mucosal immunity. (20)
Studies have shown that Candida (species) leads to an increase in tartaric acid in urine and
bowel samples. Tartaric acid competes or inhibits the activity of malic acid in the Krebs cycle,
thus reducing energy production.
It was also found that the Candida (species) leads to an increase in arabinose in urine and
bowel samples. Arabinose binds with lysine and arginine residue. This forms a penosamide
cross-linking between lysine, arabinose and arginine. This cross-linking impairs catalytic sites
for lipoic acid, vitamin B6 and biotin as well as initiating an autoimmune response. Crosslinking of proteins results in poor nutrient flow through cell membranes resulting in loss of
bowel function.
Clostridia (spore formers) cause an increase in dihydroxyphenylpropionic acid (DPPA).
DPPA is a false neurotransmitter that reacts with dopamine and noradrenaline receptors.
This alters the levels of dopamine and noradrenaline and may give rise to schizophrenia and
behavioural problems.
Thus, treatment of intestinal parasites, gut dysfunction and food allergies need to be
considered in the treatment of ADHD.
Nutrient Deficiencies and Imbalances
Assessment of ADHD children often reveals nutrient deficiencies or imbalances which, when
corrected, result in considerable behavioural and academic improvement. In a series of
studies that spanned 18 years, Schoenthaler found that a vitamin-mineral supplement
produced significantly less antisocial behaviour than did placebos. Cognitive performance
was also significantly improved.(22)
Zinc
Zinc is of primary importance in ADHD, as it is an important cofactor in metabolism, relevant
to neurotransmitters, fatty acids, and prostaglandins and indirectly affects dopamine
metabolism.(23)
Several studies conducted in different countries have found zinc to be low in ADHD
sufferers.(23) Serum zinc can be markedly below normal, and urinary zinc clearance can be
lower, both findings are suggestive of poor zinc intake and/or absorption.
Zinc deficiency can result in weakened immune system responses and diminished digestive
system function. Children who are zinc deficient are often picky eaters who will only eat a few
foods – this of course worsens the zinc deficiency.
Studies have also shown that children with ADHD who are unresponsive to stimulant drugs
are more likely to be zinc deficient than children who respond favourably to these
medications.(24)
In addition zinc is an important component of the enzyme, delta 6 desaturase, which converts
omega 3 fatty acids to DHA.(17) This could explain why children with low levels of zinc also
have low levels of essential fatty acids in the blood.
Vitamin B6 (pyridoxine)
Studies have shown that pyridoxine can help ameliorate hyperactivity. (25) Vitamin B6 is an
essential cofactor for a majority of the metabolic pathways of amino acids, including
decarboxylation pathways for dopamine, adrenaline and serotonin.
Coleman reported that B vitamins improved the behaviour of some children with ADHD in a
double blind cross over comparison with methylphenidate.(25) It was also observed that high
dose vitamin B6 reduced the symptoms while boosting serotonin levels into the normal range.
Magnesium
Another trace mineral that is highly important in ADHD is magnesium. This mineral has a
multitude of uses within the body including the activation of several hundred different
enzymes. Magnesium, like zinc, is a necessary cofactor required by the enzyme delta 6
desaturase.
Magnesium is also a calming mineral that relaxes nerves and muscles and diminishes the
effects of stress.(27) Recurrent infections, food or environment allergies and gastrointestinal
parasites can all result in excessive magnesium loss.(27)
Low magnesium may be associated with hyperactivity due to hyperirritability of brain neurons.
Studies have shown that supplementation with magnesium can improve behaviour and
cognitive performance in children with ADHD.(28) Adults with ADHD are also likely to require
magnesium supplementation. Avoiding stimulants like caffeine, nicotine or amphetamines, as
well as learning to manage stress and addressing physical problems such as chronic
infection, allergies, gut dysfunction and parasitic infestation, are all important factors which
will help to decrease further magnesium loss.
Essential Fatty Acids (EFA’s)
Several studies have indicated that some physical
symptoms reported in ADHD are similar to
symptoms observed in essential fatty acid (EFA)
deficiency. One reliable symptom of EFA
deficiency is excessive thirst (polydipsia) without
matching polyuria.(29)
An English ADHD support group reported that
children with hyperactivity were significantly
thirstier than children who were not hyperactive.
Mitchell measured plasma fatty acids in 100
children and found hyperactive children had
significantly lower concentrations of DHA,
arachidonic acid and DGLA.
Phosphatidyl Serine
Phosphatidyl serine is clinically proven to benefit a wide range of brain functions. (30) This
phospholipid occurs in the brain at far higher concentrations than it does in other organs. It is
a key constituent of nerve cell synaptic membranes, which are deeply involved in the
production of neurotransmitters.
Ingested as a supplement, phosphatidyl serine energises the human brain, facilitating
synaptic connectivity and specifically boosting dopamine transmitter functions i.e. its
production, release, and post synaptic receptor actions.
In a study of ADHD children aged between 4 and 19 years, dietary supplementation with
phosphatidyl serine benefited greater than 90% of the cases.(32) At intakes of 100-300
mg/day of phosphatidyl serine, attention and learning were most consistently improved.
Karen Donchak
For additional information, please contact:
Bio Concepts
PO Box 1492
Eagle Farm BC, Qld 4009
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