01.12.2006

Focusing Attention on ADD and ADHD

We continue our look over recentmonths at major health problems affecting our youngpeople. Nutritional toxicologist Dr Peter Dingle examinesthe complex and troubling spectrum of Attention DeficitDisorders.

AttentionDeficit Disorder (ADD) and Attention Deficit HyperactiveDisorder (ADHD) are neurological disorders that affectmainly young children.

Children are classified as ADD when they show signsof inattention, such as a lack of close attention todetail, difficulty in sustaining attention or are easilydistracted. Some children may be underactive (hypoactive),inflexible, suffer from speech disorders and have poorshort-term memory, and show sleep and appetite changes.ADHD has the added signs of hyperactivity such as fidgeting,being always "on the go", disruptive or demonstrateother signs of hyperactivity.

While there are more precise definitions for theseconditions, they are mostly subjective and open to variousinterpretations. ADD/ADHD are relatively new conditionsand were probably defined as soon as a pharmaceuticalcompany had a drug to use.

As more investigation is done on these disorders, morecontroversy is raised about possible origins and causes.It's likely that ADD/ADHD occurs because of a complexrange of factors, including illnesses and a combinationof susceptibility factors such as genetics, maternaldiet during pregnancy and length of breast feeding.The child's exposure to various chemicals in both foodand the environment and their current diet are alsoprobable contributing factors.

Some chemicals and foods may act as a trigger for thedisorder. Whatever the cause, it seems likely from thenature of the symptoms that ADD/ADHD has many contributingfactors. No cases are identical, especially when dealingwith children. ADD/ADHD, however, is definitely nota deficiency of Ritalin or any other drug.

Surveys suggest that as many as 49 per cent of boysand 27 per cent of girls are described as inattentiveby their teachers, while serious deficits in attentionappear to occur in at least three to 10 per cent ofschool-age children, making inattention among the mostprevalent of all childhood neuro-psychological disorders.Many of these children are diagnosed as having ADD/ADHD.

Many studies identify a worsening of symptoms withcertain foods or food additives; others link lead contamination,smoking and alcohol in pregnancy to developmental disordersin children. The possibility of chemical substancesin the diet and the environment influencing ADD/ADHDis highly likely.

Sadly, little real evaluation of ADD/ADHD childrenis actually carried out. They are not routinely evaluatedfor chemical, nutritional or allergic factors, or assessedfor behavioural or environmental issues arising fromtheir home environment. Instead, they are given drugs.This is despite the fact that there is a growing bodyof scientific literature showing significant nutritionaldeficiencies in many of these children. There is growingevidence that a significant number of ADD/ADHD sufferershave a high body burden of heavy metals, particularlylead, mercury, cadmium and possibly even the trace elementcopper. These metals are potent toxins which block thousandsof important chemical reactions in the body and canplay havoc with the nervous system. At even moderateconcentrations, lead can lower a child's IQ. Recentresearch links infant and maternal exposure to leadwith higher rates of schizophrenia.

Nutritional deficiency is an underlying cause of ADD/ADHDin a significant number of children. Correcting thesedeficiencies and inbalances can make substantial improvementsin childrens' behaviour. Sometimes improvement is almostimmediate.

The basic problem appears to be deficient levels ofneurotransmitters (chemicals that coordinate many ofthe body's and mind's activities) in brain cells. Variouschemical substances affect the transmission of messagesacross the synapse, the gap between individual nervecells. Acetylcholine, adrenalin, noradrenaline, dopamine,gamma-aminobutyric acid (GABA) and serotonin are allexamples of neurotransmitters. Some of these chemicalsare responsible for other chemical secretions and uptake.They control muscular activity, mood and behaviour.So you can see how they might be involved in ADD/ADHD.

Over-prescription of drugs, (particularly the amphetamineRitalin, one brand name for methyl phenidate) that managethe symptoms of the disorder, is common. In WesternAustralia, in particular, the annual use of prescriptionamphetamine-like tablets prescribed for ADD/ADHD hasexploded. There are many problems associated with takingthese drugs. They include anorexia, weight loss, insomnia,lability of mood, nervousness and irritability, abdominaldiscomfort, excessive withdrawal symptoms, heart arrhythmias,palpitations and psychological dependence. Suicide isalso a major complication of withdrawal from amphetamine-likedrugs. Children on Ritalin are more prone to becomingaddicted to smoking and illicit drugs. These drugs don'tdeal with the underlying cause. The US National Instituteof Health has concluded that there is no evidence thatRitalin brings about any long-term benefit in scholasticperformance.

These drugs have a noradrenaline-like action. Noradrenalinenormally acts to coordinate many nervous system functions.It's thought to filter out unimportant stimuli, reducingthe number of distractions sensed by the child. If ADD/ADHDis a noradrenaline shortage, it could be measured, butno one seems to want to do this. It's much easier (andmore profitable?) to prescribe drugs. If it's a noradrenalineshortage, it can at least to some degree, be correctedby dietary measures.

There are many reasons as to why a child may havepoor nutrition. These include being breast-fed for onlya short period of time. Infant milk formulas and cows'milk are not the same as human milk. Cows' milk is greatfor a calf that needs to put on weight directly afterbirth. A cow's brain does not grow after birth. Thehuman brain continues to grow substantially up to theage of three, and then more slowly, up to 18 years ofage. It's not surprising then, that human milk is highin Essential Fatty Acids (EFAs) and choline, along withmany other ingredients essential for the developmentof a healthy brain and nervous system. Both these nutrientsare severely deficient in many infants' and children'sdiets, particularly if the diet is high in grains andprocessed foods.

One explanation for the higher rates of ADD/ADHD inmales is that males have a higher demand for EFAs (Omega3 oils). Males don't appear to absorb them well andare less efficient at converting them to an importantgroup of chemicals called prostaglandins. Prostaglandinsregulate many activities in the body and play an essentialpart in others. Many of the foods that are linked withADD/ADHD also inhibit the conversion of the EFAs toprostaglandins. These are such foods such as wheat,dairy and salicylate-containing foods, including someof the food colours. Conversion is also blocked by deficienciesin Vitamins B3, B6, C, biotin, zinc and magnesium. Thereare many studies now that show the benefit of supplementingthe diet with fish oils and flax seed oil, not onlyfor adults but for kids being treated with Ritalin.What's also interesting about the EFAs is that manyof our parents were dosed with them once or twice aweek in the form of cod liver oil.

ADD/ADHD children appear to be deficient in a numberof nutrients:
* Vitamin C
* Vitamin B3
* Zinc
* Magnesium; and
* Essential fatty Acids (Omega 3 rich oils).

It may be that there is an absence of these nutrientsin the diet. It may be the effects of medication, stress,and other lifestyle factors, including exposure to someenvironmental contaminants, that have lead to nutritionaldeficiencies. For example, the use of antibiotics hasbeen shown to have an effect on the nutritional statusof children, as they deplete the body's levels of zinc,calcium, chromium and selenium. Antibiotics, other medicationand food preservatives can also have a serious detrimentaleffect on the healthy gut bacteria which, in turn, affectsthe ability of the gut to absorb nutrients.

Academic performance and behavioural problems improvesignificantly when children are given optimal nutritionand nutritional supplements. In one study, supplementingwith just 200 milligrams of magnesium for six monthsimproved magnesium status and significantly reducedhyperactivity. Magnesium plays a key role in the productionof noradrenaline. One of the main sources of magnesiumin our diets is green vegetables, but few kids get enoughof these. Other nutrients involved in the productionof noradrenaline include manganese, iron, copper zinc,Vitamin C and Vitamin B6.

Noradrenaline formation may be affected by an absenceof the amino acids L-phenylalanine or L-tyrosine, whichare its building blocks. Vitamins B1, B2, B3, B6, VitaminC, Folic acid and the minerals zinc, magnesium and copperare necessary for the conversion of phenylalanine andtyrosine to noradrenaline.

It has been proposed for many years that food additivesand other food constituents can contribute to ADD/ADHD.While this is refuted by the food additive industry,there's growing evidence that this is the case. It'salso becoming apparent that there are biochemical explanationsas to why some foods and food additives, particularlythe food colours, may be contributing factors. For example,salicylates inhibit the conversion of the EFAs to theprotective prostaglandins, as mentioned earlier. Manyfoods that contain salicylates - tomatoes and grannysmith apples, as well as aspirin and the food colourslike tartrazine (102) - may exacerbate ADD/ADHD.

Food additives linked with ADD/ADHD can also depletethe body of vitamins and minerals. Tartrazine decreasesblood levels of zinc and increases its excretion inthe urine.

Foodadditives to avoid are
102, 107, 104, 110, 120, 122, 123, 124, 127, 129,132, 133, 142, 151, 153, 155, 160b, 168, 173,250, 251, 252, 282, 320, 321, 420, 421, 621 (MSG)622, 624, 627,631, 635, 951.

The diet of the pregnant and breast-feeding motheris very important. Infant and early childhood healthconditions have a big role in the health of middle childhood.This is supported by research on alcohol exposure atvarious stages of pregnancy, hence the importance ofgood foetal and childhood nutrition.

What to do about food

For any child with ADD/ADHD it's important to identifyfoods that may be causing a problem. This is best donewith a professional such as a naturopath, or a doctorspecialising in nutritional and environmental medicine.With these professionals you can devise an eliminationdiet to identify potential environmental and dietaryculprits. Some of the culprits are shown below.

The main foods causing sensitivities and allergiesinclude:

Cow's milk and associated dairy productsSome legumes - soybeans, peanutsNuts and seeds -pistachio nuts, cashews, macadamianuts, cottonseedCrustaceans - shellfish, shrimpsFruits (non-citrus) - cherry, appleCitrus Fruits - oranges, lemons, limesWheat and Other Grains - corn, rice, rye, oats,barley, buckwheatCola nut products - chocolate, colaSpices - cinnamon, bay leaf, peppers, peppermint,oregano, sage, thyme, cuminFood Additives - coal tar dyes, preservatives,flavour enhancers, artificial sweetenersCaffeine - coffee, tea, chocolate, cola drinks.

The brain uses only glucose for energy. The researchon sugar suggests that it may not be a major factorin ADD/ADHD. However, brain glucose that comes in wavesof high highs and low lows is likely to affect a kid'smood.

Professor Peter Dingle
is Associate Professor
in Health and the Environment
at Murdoch University
in Western Australia.

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