Archives for November, 2008

The Three “Rs”

Reading, ‘Riting & Ritalin?

Attention deficit-hyperactivity disorder (ADHD) was a rare condition 50 years ago. Today, it is extremely common, affecting an estimated 5-20% of all children in the United States. Previously known by a number of different names (including hyperactivity, hyperkinesis, and minimal brain dysfunction), ADHD is characterized by learning disabilities, short attention span, easy distractibility, impulsive behavior, hyperactivity, and lack of coordination. Although children with ADHD are not mentally retarded, they often do poorly in school and have difficulty making friends.

Conventional medicine has discovered that methylphenidate (Ritalin, a chemical related to the amphetamines) is often effective for children with ADHD. For reasons that are not understood, stimulants like Ritalin produce a paradoxical response in these children: slowing them down and helping them concentrate, rather than speeding them up.

Unfortunately Ritalin has many side effects and does not address the cause of ADHD, it merely suppresses the symptoms. Nevertheless, both teachers and parents sometimes look at Ritalin as a quick fix, or as the simplest way to deal with a complicated problem. Indeed, in some parts of the United States, as many as 6% of grade-school children are on this drug.

Diet: The Source of the Problem?
Dietary factors and nutritional supplements also play an important role in the treatment of ADHD. Some children are exquisitely sensitive to refined sugars and they improve greatly when all of the sugar is removed from their diet. Some children react to artificial colorings (particularly tartrazine, also known as Yellow Dye #5) and other synthetic chemical additives. A substantial proportion of children are allergic to common foods such as milk, wheat, egg, corn, or citrus. Parents, with the help of medical professionals, can put their child on an elimination diet. After about three weeks, if there have been noticeable improvements, the foods and additives are reintroduced one at a time, observing for reactions. Foods that provoke symptoms or behavioral changes are removed from the diet.

Elimination-and-rechallenge diets should be medically supervised to insure that they contain adequate amounts of protein, vitamins, and minerals and that the results are interpreted correctly. In my experience, about 50-75% of children with ADHD improve considerably if they exclude the offending foods and/or additives from their diet.

Why the Controversy?
When children with ADHD improve, the results are often dramatic. It is therefore surprising that most doctors do not believe diet has much to do with this condition. This skepticism arises in part from some bad research that appeared in popular medical journals and subsequently received widespread media exposure. For example, a study published in the prestigious New England Journal of Medicine concluded that dietary sugar does not affect behavior or cognitive function in hyperactive children (1994; 330:301-7). In that study, which compared the effects of a high- and low-sugar diet, the so-called “low-sugar” diet actually contained 5.3 teaspoons of refined sugar per day. That amount of sugar is enough to cause symptoms in a sensitive child, rendering comparisons between the two diets meaningless.

Numerous studies have investigated the Feingold diet, which is based on Dr. Ben Feingold’s observation that artificial colors and food-derived chemicals called salicylates contribute to ADHD. A few of these studies found that the chemicals caused only minor problems, and other studies found no effect at all. However, much of the research was seriously flawed.

Vitamin Supplements Are Part of the Equation.
Vitamin supplements have also been used successfully to treat children with ADHD. Some hyperactive children have a deficiency of the neuro- transmitter molecule serotonin. Best known for its relationship to depression, serotonin deficiency also seems to play a role in ADHD. In hyperactive children who had subnormal blood levels of serotonin, treatment with large doses of vitamin B6 (15-30 mg/kg of body weight) was found to work even better than Ritalin (Biol Psychiatry 1979;14:741-51). It should be pointed out that not all children with ADHD are low in serotonin. Furthermore, the doses of B6 used in this study were extremely large and must be monitored by a physician. Fortunately, lower doses of vitamin B6 are sometimes helpful when combined with appropriate diet changes.
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