ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment, Food and Drink

Does ADHD have anything to do with enzymes and can No-Fenol enzyme supplements help?

Mary, a long time friend of Myomancy, dropped me a line recently about ADHD and diet with a link to information on enzymes and ADHD. Enyzmes act as a catalysts for the chemical reactions that drive our biology and each has a specific role to play. The article promotes the use of No-Fenol, an enzyme supplement that is typical of the type on the market.

When I looked at ADHD and diet, I found there was no evidence of a poor diet causing ADHD. The best advice I could find was to eat a balanced diet with plenty of fresh fruit and vegetables. This won’t directly help with the ADHD but you will feel better and it helps to avoid weight problems (see ADHD and Obesity). However there was connection between omega-3 and ADHD . Supplements of fish oils did help some people on some specific tasks. Could enzyme supplements help ADHD in the same way?

The logic behind enzymes supplements is that by increasing the number of enzymes in the digestive system all the food you eat will be processed more efficiently. This will ensure that all the vitamins and minerals needed at picked up from our food. This presupposes that ADHD is caused by vitamin or mineral deficiencies, a position that is questionable.

Searching both Google Scholar and the maker of No-Fenol’s web site I can find no evidence to say that enzymes supplements help ADHD. In fact I can’t find a single piece of evidence that enzymes supplements can help with anything other highly specific medical conditions such as cystic fibrosis.

Diet and ADHD is an area that is rich in advice, supplements and books. Most of these are done with the best intentions but lack any direct evidence for their claims. Companies use science to show how Ingredient X helps with Vitamin Y that has been linked to Problem Z but that doesn’t mean the taking more X or Y will help with Z. Before taking any supplement its worth asking to see research showing that the specific product you are considering buying works on your problem. If they can’t then their claims are speculation at best.

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ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment

Do ADD / ADHD medications increase the risk of drug and alcohol abuse problems in later life?

According to a 2003 study, the answer is no. In fact the use of ADD / ADHD medication significantly reduced the chance of drug and alcohol use in later life. THe study analyzed the data from six different studies covering a total of 674 people with ADHD who were medication and 360 who were not. All the participants progress had been followed for at least four years and monitored for drug or alcohol problems. This runs counter to animal research on the effects of ADHD medication on drug usage and just demonstrates how complicated this area is to research.

There are many different factors from genetics to poverty that can influence people’s decent into addiction. It has been thought that the use of ADD / ADHD medication might train or condition the central nervous system to expect stimulation. This might drive the user to pursue other forms of stimulation either through drugs or other high risk behaviour. This study suggests that by using the medication, the person with ADD / ADHD gets more control over their life and is less tempted by alternative medication.

Previously on Myomancy:
ADHD, Children and Medication
Stim Nation: Ritalin and Cocaine Addiction
Stim Nation: Adderall Use, Abuse & Addiction
ADD / ADHD Medication

Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-analytic Review of the Literature

ADD / ADHD, ADD / ADHD Treatment

How can motherly love reduce ADHD symptoms?

Low birth weight infants, often born prematurely, have a range of health issues including ADHD and other learning problems ( Extremely Low Birth Weight Children and Learning Disorders ). In an remarkable study by King’s College, London and the University of Wisconsin, researchers talked to the mothers of twins born with low birth weight once the children were five years old. By analyzing how the mother talked about the twins they assigned a maternal warmth score. This score was based on the tone of voice, spontaneity, sympathy, and/or empathy toward the child. The persons conducting the interviews were all highly trained with appropriate scientific backgrounds to ensure that maternal warmth scores were objective measures. The mothers were also asked to rate the children’s for signs of ADHD as were the children’s teachers. The twins IQ was also measured.

As expected the study found a link between more ADHD, lower IQ and low birth weight. They also found that larger maternal warmth scores were linked to lower ADHD symptoms however it found no link to IQ. A strong maternal bond to infants is important in many ways but it appears that it is especially important for those at risk of ADHD. Building a close and loving link between parent and child in those all important infant and toddler years can help prevent ADHD.

Does Maternal Warmth Moderate the Effects of Birth Weight on Twins’ Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms and Low IQ? [ PDF ]

ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment

Adderall XR is the most prescribed ADHD medication but what are the side effects and dangers of this using drug?

Side Effects

Adderall’s side effects, or contraindications as they are properly known, identified in the drug trials are in most cases mild and relatively infrequent. During Adderall’s drug trials poor appetite, stomachaches, and insomnia were the generally reported side effects by parents but headaches were rated notably more significant when children were receiving higher doses of Adderall.

The frequency of these side effects do vary from trial to trial depending on dose and age of the participants. In trials on children, loss of appetite occurred 10 more often as an Adderall side effect than the placebo or chance frequency. It affected 22% of those taking Adderall. Insomnia was seven or eight times more likely and affected 17% of those on the drug. In adults headaches were twice as frequent (26% of users) and loss of appetite ten times more likely (33% of users).

The data doesn’t reveal how many users suffered multiple side effects but at least 20% of all users of Adderall suffer a side effect and it could be 40% or more.

Adverse Events

An adverse event is a significant change in health whilst taking the medication. These may not be an Adderall’s side effect but if it occurred during a clinical trial it has to be recorded. Generally an adverse event is serious enough to cause the patient to stop taking the medicine. Often these events are unrelated to the drug being tested. During two trials of Adderall, 2.4% of participants stop taking the medication due to adverse events but 2.7% of the patients receiving the placebo dropped out because of them.
In larger trials where Adderall was assessed for side effects over longer-term usage the adverse events were:

Adverse event % of pediatric patients discontinuing (n=595)
Anorexia (loss of appetite) 2.9
Insomnia 1.5
Weight loss 1.2
Emotional lability 1.0
Depression 0.7

Half of these patients had been taking Adderall for 12 months or more.

Other Long Term Health Risks

In addition to trial data, longitudinal studies and individual reports by doctors have indicated other Adderall side effects.

Psychosis is a generic psychiatric term for a mental state in which thought and perception are severely impaired. Persons experiencing a psychotic episode may experience hallucinations. Amphetamines (one of Adderall ingredients) have been known to amplify exisiting psychosis. It is unclear if long term usage will cause psychosis in a previously healthy patient.

As Adderall is a relatively new drug, the longer term effects are not known but some data has indicated that it and other stimulants may stunt growth. Other research suggests that children with ADHD are more at risk of stunted growth generally.
Sudden death in Adderall users is linked to those with patients with existing heart problems. Only twenty five patients have died after taking any form of ADHD medication and many of these may not be connected to the medication.

Addicition, Withdraw and the Central Nervous System

Long term use of amphetamines generally leads to the body building up a tolerance to the drug. This forces doctors to prescribe higher dosages or switch the patient to other, possibly less suitable, medications. The constant stimulation of the central nervous system may lead to dependence on the drug with severe problems when the drug is stopped. Long term usage may also increase the chance of cocaine addiction, a stimulant similar to amphetamine.

Previously on Myomancy:
Adderall Use, Abuse & Addiction
Addicted To Adderall
Ritalin and Cocaine Addiction
ADD / ADHD Medication

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ADD / ADHD, ADD / ADHD Treatment, Dyslexia, Dyslexia Treatment, Food and Drink

Omega 3 fatty acids are seen as a natural remedy for ADHD and dyslexia but can you get your Omega 3 and Omega 6 through a normal diet?

There are plenty of Omega 3 and Omega 6 supplements on the market, costing about £20 ($30) for a month’s supply. Not everyone can afford this so I’m going to attempt to identify what and how much you need to eat to get them naturally. As a basis I’m going to set as my target the same amount of omega 3 and 6 as the EyeQ supplements. These were used in a large scale trial in Durham, UK, that had significant results. In this trial children received 558 mg of EPA and 174 mg DHA (omega 3 oils) and 60 mg of LA (omega 6). [For more on the difference between EPA, DHA and LA see ALA to DHA: The Fish Oil Alphabet].

Getting Your LA

LA is Linoleic Acid, named after the Greek for the plant Flax, more commonly known as Linseed. Its name is not a coincidence because LA is prevalent in most vegetable oils. To get 60 mg of LA in your diet you would need to eat any of the following:

Food Grams Required LA grams per 100 grams of food
Butter 6.3 0.95
Walnuts 0.15 39.29
Chedder Cheese 19.3 0.31
Fruit Yogurt 20 0.03

As you can see it is very easy to get LA into your diet. In fact the problem is that we have too much LA in our diet generally because LA interferes with our ability to process omega 3 fatty acids. A ratio of 2:1 omega 6 to omega 3 is recommend by some experts. Studies have shown that the average western diet can have between a 10:1 and a 18:1 ratios. The foods identified above also contain omega 3 ALA but have a relatively low, 4:1 or less, ratio.

There Is Something Fishy About EPA

EPA is an omega 3 fatty acid. The body can convert it from Alpha-Linolenic Acid (ALA, the omega 3 equivalent of LA) but the process has only a 5% – 10% efficiency, so at least 5.58 grams of ALA are need generate 558 milligrams of EPA. To get that much ALA you would need to eat about 10 kg of spinach a day, a feat best left to Popeye.

To avoid a diet fit only for a rabbit, we need to get our EPAs direct from our food:

Food Grams Required EPA grams per 100 grams of food
Tuna 1000 0.06
Mackerel 78 0.71
Crab 118 0.47
Beef 5580 0.01

As you can see fish are the most practical way of getting your EPA with obvious advantages over eating 5.58 kg of beef or 10 kg of spinach a day. However there is a problem with heavy metals in fish. There is a certain irony that the food stuffs we most need to develop our brains are the ones most likely to be full of brain destroying heavy metals. Mackerel contains about 55 parts per billion (ppb) of mercury and tuna 118 ppb. The US FDA sets a safety level of 1000 ppb so a can of tuna is safe. A problem arises because mercury can accumulate in the body so a regular diet of tuna or mackerel may lead to dangerously high levels of mercury. The FDA guidance is no more than 2 meals of tuna a week for pregnant women and children.

End of the Line for DHA

The end result of our bodies processing of ALA is DHA and it is between 2% to 5% efficient. So 100 milligrams of ALA become 2 to 5 milligrams of DHA. Like EPA, DHA is common in fish:

Food Grams Required DHA grams per 100 grams of food
Tuna 64 0.27
Mackerel 15 1.10
Crab 60 0.45
Beef 0

Making a Meal Of It

Getting the balance of omega 3 and omega 6 fatty acids in your diet without poisoning yourself with heavy metals is very difficult. It must also be noted that the amounts and ratios of omega 3 and 6 used by the Durham trial are educated guesses. Research on the best combinations has been very limited.

Ultimately the advice is the same as all nutritional advice. Eat a varied diet with lots of fresh vegetables, fruit and nuts. Have sensible sized portions of fish two or three time a week and avoid fatty, processed foods.

Previously on Myomancy:
ALA to DHA: The Fish Oil Alphabet
ADHD and Omega Fish Oils

The LCP Solution
What can high-omega-3 foods do for you?
Vegetarian Society: Omega 3 Fats
The Essential Omega-6 and Omega-3 Fatty acids in Food [ PDF ]
Mercury and Fatty Acids in Canned Tuna, Salmon, and Mackerel [ PDF ]
Alpha-linolenic acid in the prevention and treatment of coronary heart disease [ PDF ]
What You Need to Know About Mercury in Fish and Shellfish

ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment, Food and Drink

Omega 3 and Omega 6 have been touted as the natural remedy for ADHD but what is the actual research evidence?

Research into Omega 3 & 6 (also known as Long Chain Polyunsaturated Fatty Acids or Essential Fatty Acids) and hyperactivity started in the early eighties and really took off in the nineties. A 1995 study found that 54 hyperactive children had significantly lower amounts of fatty acids in their blood stream. A similar study in 2004 found that adults with ADD / ADHD also have lower levels of fatty acids

Once the idea that people with ADHD had lower levels of fatty acids, the next step was to provide supplements and see if behavior changes. One of the very earliest studies in 1987 used evening primrose oil but found that children only improved in two out of the 42 criteria they were assessing the children with. They concluded that gamma-linolenic acid (GLA), the active ingredient of evening primrose oil, was ineffective.

Docosahexaenoic acid (DHA) is what Omega 3 (Alpha-Linolenic Acid or ALA) is converted to in the body. A 2001 study using 63 children with ADHD found no difference in behaviour or academic performance after four months of taking 345 mg daily. This is backed by a 2004 Japanese study that used foods supplemented with DHA. They found no improvement in hyperactivity, impulsivity, aggression, visual perception or visual-motor integration.

In 2003, a team from Purdue University in Indiana, USA tested the effects of a daily dose of 480 mg DHA, 80 mg eicosapentaenoic acid (EPA), 40 mg arachidonic acid (AA) and 96 mg GLA for four months. Results were mixed and no clear benefit was observed though the results were interesting and suggested further research was needed.

In Oxford, UK, Dr Ricardso conducted a pilot study in 2002. He found that cognitive problems and general behavior problems fell significantly during the trial. He expanded the research to a large scale trial in 2005. This study was widely reported in the news and followed 117 children from 12 schools in Durham, UK. These children had been diagnosed with Developmental Coordination Disorder (DCD) rather than ADHD. DCD is a motor control problem and overlap with ADHD, dyslexia and autistic spectrum disorders. The study used omega-3 fatty acids containing 558mg of EPA and 174mg DHA and omega-6 fatty acids containing 60mg of linolenic acid (LA). Also included was 9.6mg of Vitamin E. The results showed significant improvements in reading, spelling and behavior but did not identify any effect on motor skills.

The studies are the only research done on Omegea fish oils and ADHD. Most research on the fish oils has focused on dyslexia and general health benefits.

It is clear from the results of these trials that taking omega 3 and omega 6 fish oils is not an instant cure for ADD / ADHD. Though as one research noted, the effectiveness of omega fish oil in trials is about 60% that of Ritalin and not one side effect has been reported. Whether fish oils are going to be beneficial for a particular person is unclear. Those who are co-morbid with dyslexia or are generally having reading problems probably will benefit.

It is also important to note that the ideal dose or mix of omega fish oils has not been identified. A mix of 4 to1 omega 3 to omega 6 plus a supplement of vitamin E has been suggested as effective by some of the research.

A month’s supply of ‘Eye Q’ capsules, as used in the Durham trial, will cost about £20 ($30). Most trials have been conducted over three to four months but some benefits were noted after just one month. If you can afford the supplements and are prepared to take them every day (something that people with ADHD might find hard) then they are worth trying but don’t expect miracles.

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ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment, Food and Drink

Can caffeine be used as a natural alternative to ADHD medication?

The active part of caffeine is methylxanthine is a mild stimulant that activates noradrenaline neurons and seems to affect the local release of dopamine, a key neurotransmitter. Dopamine plays a part in motor control and a low dopamine level is believed to be the cause of Parkinson’s disease which effect patients ability to control their movement. Another notable effect of caffeine is that it reduces the blood flow in the brain. This is similar to the effect of ADHD medications, such as Ritalin, that are stimulants, effect dopamine levels and cerebral blood flow. The cognitive effects of caffeine are also similar to ADD / ADHD medication. It makes users better a rapidly processing information and paying attention.

Studies on non-ADHD school children and caffeine are mixed. A 1987 study on Kindergarden children found no noticeable effect where as a 1994 on prepubertal children found that it did improve attention and manual dexterity. On children with ADD / ADHD the results are bit more promising. A 1973 pilot study used two cups of coffee a day as an alternative for medications and the results were promising. In 1981 caffeine was used as an alternative and as a supplement to medication. It found that caffeine in low dosage had the same effect as 10 mg of methylphenidate.

The health risks for long-term caffeine used are better understood that those of Ritalin. Mild levels of caffeine consumption, up to 400 mg for an adult male, 300 mg for a adult female and 2.5 mg per kilo for a child, is considered safe. There is evidence of a dependence on caffeine for heavy users with symptoms such as headaches when withdrawing from it. Very large amounts of caffeine can induce heart attacks and is associated with hand tremors.

For guidance, in a cup of coffee (5 US fluid ounces) there is 85 mg of caffeine for ground coffee, 60 mg for instant and 3 mg for decaffeinated. In the same sized cup of tea there is 30 mg. Cola’s have 18 mg per 6 US fluid ounce serving. A can of Red Bull contains 80 mg. As a comparison, many of the studies reference in this article used 250 mg of caffeine, the equivalent to 3 cups of fresh coffee.

It is likely that trying to replace large doses of ADHD medication with similar large doses of caffeine is likely to produce undesirable side effects. As a replacement for moderate doses of ADD / ADHD medication, caffeine may have some value. Caffeine’s effect does seem to be dependent on the user (a feature of ADHD medication as well) so your mileage may vary. Be aware that there is also large amounts of hidden caffeine in soft drinks, sweets and cold medicines so it is worth monitoring your current caffeine intake.

Previously on Myomancy
Stim Nation: Forget Ritalin, Drink Coffee
ADHD and Obesity
ADD / ADHD Natural Remedies: Part 1
ADD / ADHD Natural Remedies: Part 2

ADD / ADHD Natural Remedies: Part 3

Effects of methylphenidate on regional brain glucose metabolism in humans: relationship to dopamine D2 receptors
The acute effect of methylphenidate on cerebral blood flow in boys with attention-deficit/hyperactivity disorder
Caffeine and human cerebral blood flow: a positron emission tomography study.
The effects of caffeine on two computerized tests of attention and vigilance
Effects of caffeine on classroom behavior, sustained attention, and a memory task in preschool children.
Caffeine effects on learning, performance, and anxiety in normal school-age children.
Caffeine as a Substitute for Schedule II Stimulants in Hyperkinetic Children
query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7028238&dopt=Abstract”>Responses to methylphenidate and varied doses of caffeine in children with attention deficit disorder.
Caffeine consumption.
Effects of caffeine on human health

ADD / ADHD, ADD / ADHD Treatment, Autism, Autism Treatment, Balance & Coordination, Dyslexia, Dyslexia Treatment

Looking for something completely different I came across Sensory Edge , an online toy-shop featuring stimulating products for small children. I was particularly impressed by their balance and movement section. These toys are great for developing the cerebellum and vestibular systems, areas of the brain that are weak in children with ADHD, dyslexia and autism.