ADHD - ADD

What every parent needs to know

Attention deficit hyperactivity disorder (ADHD) has reached epidemic proportions among U.S. schoolchildren. The primary medical treatment for ADHD is the stimulant drug, Ritalin; its use has increased by 700 percent over the past five years. Although Ritalin can control some symptoms of ADHD, its long-term risks or benefits are not known, and the drug does not get to the root of the problem.

Beyond Ritalin
Scientific research shows that nutritional factors are a contributor to ADHD. I have personally treated hundreds of children with ADHD over the past 20 years, and almost all have improved without the need for Ritalin. To help them and their parents, I have used a series of questions that search for the causes of ADHD in each individual child.

The first question is: How effective are the parents at parenting? All children, especially those with behavioral problems, need affection, consistency, and the clear setting of limits. A related question is: How appropriate is the educational setting for this child? Some children need to work consistently with their hands and need to keep physically active -- these children will become restless and inattentive when deprived of physical work. Their problem is not a medical disorder, but inappropriate schooling or ineffective parenting. Fortunately, most of the parents whose children I see in my medical practice understand these principles well.

Investigating ADHD, nutritionally -- step by step
First and foremost, these parents are consulting me for nutritional advice. I ask the following questions to get the nutritional answers I need, and I recommend that you, as parents, ask these questions of your own children:

#1 How nutritious is your child's diet? Over half 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 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, however, does not cause hyperactivity; it reduces the nutritional quality of the diet and may aggravate food allergy or food intolerance (see below). Concentrated sugar in the upper intestinal tract makes the intestine "leaky," increasing the absorption of allergens into the body.

#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 compounds occur naturally in many fruits and vegetables and are especially concentrated in grapes, 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.

Thirteen 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. Sensitivity to salicylates in food is probably not a salicylate allergy, but a chemical effect of salicylates on the brain. Some researchers believe that these chemicals act to inhibit the activities of enzymes that decrease the brain's sensitivity to allergic reactions. I have seen several children with ADHD whose ability to tolerate other foods, like wheat, improved when they eliminated apple juice and grape juice.

A study performed at the Hospital for Sick Children in London, published in the leading British journal, Lancet, demonstrated that most children with severe ADHD are salicylate sensitive, but that 90 percent of these children have additional food allergies. 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 a true food allergy. The foods to which children with ADHD most commonly had allergic reactions were:

cow's milk products (which included milk, cheese, yogurt, and ice cream)
corn (an additive in many prepared foods)
wheat
soy
eggs.
Altogether, 48 different foods were incriminated as triggers for hyperactivity.

Digging deeper into the food allergy possibility
In my clinical practice, I have found that a food allergy is especially likely to be implicated in ADHD if the answer to any of the following questions is positive:

(A) Does your child have eczema, asthma, hay fever, hives, or a chronic runny nose?

(B) Do you, your spouse, or any of your other children have either severe allergies or migraine headaches?

(C) Does your child have a "geographical tongue"? (Irregular flattened patches that looked like countries on a map.)

(D) Do your child's ears turn red for no apparent reason?

(E) Does your 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 your child totally avoids all foods containing artificial colors, artificial flavors, and preservatives, and the high-frequency allergenic foods mentioned above. The best foods to use during this trial are meat, poultry, fish, rice and rice milk, oats and oatmeal, and fresh vegetables and fruits (other than apples and grapes). 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 your child experiences hyperactivity, itching of the skin, wheezing, a runny nose, or red ears when a particular food is re-introduced to the diet, he or she is likely to be allergic to that food. If allergies are found, you may need the help of a nutritionist in developing a nutritionally adequate diet for your child that avoids the foods to which he or she is allergic.

#3 Does your 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 your child have dry skin or 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 (EFAs), which are found in flax oil, fish oils, or evening primrose oil. A study done in the Department of Foods and Nutrition at Purdue University found that boys with ADHD had significantly lower concentrations of certain EFAs in their blood. The lowest levels were found in those boys with the symptoms I just listed.

There is no single supplement that will meet the needs of all children, but I start treatment with organic flax seed oil, 1 to 2 teaspoons a day. I choose flax oil because it meets the needs of most American children for EFA supplementation and is loaded with beneficial antioxidants. If there is no improvement in behavior, concentration, or dryness of the skin or hair, I replace flax oil with evening primrose oil, which is available in capsules. The dose used is two 500-mg capsules a day for infants and toddlers, three to four a day for children aged 3 to 10, and five or six capsules a day for older children. If your child cannot swallow capsules, you can open them and mix the primrose oil into food or massage it into the skin. The EFAs in primrose oil are absorbed well from the soft skin of the chest, back, and forearms. If neither flax oil nor primrose oil help your child's behavior, try adding an oceansource DHA (docosahexaenoic acid) supplement. DHA is the leading EFA in the brain. The dose needed is 100 to 400 mg/day.

(B) Does your child complain of stomach aches, headaches, or muscle pains, or is sleep difficult 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 less than the RDA of magnesium. Second, the high adrenaline levels associated with hyperactivity cause them to excrete excessive amounts of magnesium in the urine, thus depleting their bodies of magnesium. Research from Germany and France reveals a high frequency of magnesium deficiency in hyperactive children, especially those with headaches or abdominal pain. In my medical practice, I have found magnesium supplementation to be especially useful for sleep disturbances in children with ADHD, although the effects on hyperactive behavior are small. The dose needed is 100 mg per day for younger children and 200 mg for older children, each dosage taken at bedtime.

If your child's diet is low in calcium, it may be necessary to add a calcium supplement, also taken at bedtime, 400 mg for younger children, and 800 mg for older children. A possible side effect of magnesium supplementation is diarrhea, whereas a possible side effect of calcium supplementation is constipation.

(C) Has your 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. The dose needed is I billion to 5 billion organisms per day. Anti-yeast medications may also be useful if yeast overgrowth is suspected. Their use should be discussed with a health practitioner.

#4 Does your mild have difficulty with learning?

Learning-disabled children often benefit from nutritional supplements that enhance brain function. As the learning difficulties improve, hyperactivity also improves. The most useful supplements for enhancing learning in children with learning difficulties are B-complex vitamins, zinc, dimethylaminoethanol (DMAE), and phosphatidyl serine (PS).

Zinc is important for immune function and for brain function. The dose needed is 10 mg per day for younger children, 20 mg per day for teens.

DMAE is used by the brain to make choline, a neurotransmitter used for memory and thinking. A dose that can improve learning and behavior in children is 600 to 1,200 mg per day. How it improves learning is not known, but it also has been shown to boost immunity and athletic performance with almost no side effects. The dose needed is 200 to 300 mg per day. The benefits of these supplements may not be obvious until six weeks after being started.

The effect of B-complex vitamins can be paradoxical. Some children with ADHD become more hyperactive when taking B-vitamins; if this occurs, each of the B-vitamins should be administered individually. If there is no increase in hyperactivity, go with a B-complex supplement, indefinitely.

Does your child have ADHD?
In her book, No More Ritalin: Treating ADHD Without Drugs, Mary Ann Block, D.O., P.A., points out that the "textbook" symptoms of ADHD are "highly subjective." However, she does believe that if a child's behavior interferes with life at home or in school; then that child needs help. Excessive inattentiveness, impulsivity, and/or hyperactivity seem to be the most common indicators that your child may have ADHD or another health problem.

PHOTO (COLOR): Over haft of children with ADHD crave sweets

REFERENCES
Block, Mary Ann, D.O., P.A. No More Ritalin: Treating ADHD Without Drugs. New York: Kensington Books, 1996.

Egger, J., Carter, CM., Graham, P.J., et al. "Controlled trial of oligoantigenic treatment in the hyper kinetic syndrome," Lancet 1:540-545, 1985. Galland, L "Magnesium, stress and neuropsychiatric disorders," Magnesium and Trace Elements 10:287301, 1991.

Stevens, L.J., Zentall, S.S., Deck, J.L, et al. "Essential fatty acid metabolism in boys with attention deficit hyper activity disorder," American Journal of Clinical Nutrition 62:761-768, 1995.

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By Leo Galland, M.D.

Leo Galland, M.D., is the director of the Foundation for Integrated Medicine, NY. A frequent and dynamic speaker in the nutritional/alternative medicine industry, Galland is also the author of Power Healing (Random House, 1998) and Superimmunity for Kids (Delta, 1989).

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