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ADHD - Exploring risk factors and natural treatments

Dr. Brian Casteels
6 November 2014

ADHD - Exploring risk factors and natural treatments

by: Brian Casteels, ND

210 Willmott St. Unit 5D
Cobourg ON
K9A 4S3




ADHD - Exploring risk factors and natural treatments




Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurological concern. The estimated prevalence in children is approximately 5.29% worldwide.[1] A Dutch study found that 70% of these children may continue to be affected as adults.[2] Some features of ADHD include: increased inattention, impulsivity, and hyperactivity.[3] ADHD has been associated with obesity and childhood inactivity,[4] addictions,[5] increased risk of injury,[6] decreased academic achievement, as well as occupational and social challenges.[7] Therefore, it is important to understand what can be done to decrease the potentially negative impact of ADHD on people's lives.

The first line of treatment for ADHD is generally behavioural therapy and stimulant medications.[8] Although stimulant medications are often considered safe, they are associated with some negative side effects, such as insomnia, headaches, anorexia and weight loss.[8] There is also some concern about cardiovascular health, growth retardation [8] and abnormal prefrontal brain function and development.[9] Having a better understanding of the causative and aggravating factors of ADHD offers insights into improved treatment options. There are a number of dietary, life-style and alternative complementary practices that may be used in ADHD. Utilizing these complementary practices has the potential to reduce reliance on medications and/or improve overall treatment results.


Causative and Aggravating Factors of ADHD Causative and Aggravating Factors of ADHD

It has been shown repeatedly that tasks measuring executive functions are often impaired in children with ADHD.[10] This is thought to be a result of atypical development in these areas, with the potential for a number of factors to influence the ADHD phenotype.[10]

Environment and Epigenetics

Environmental agents have been implicated in ADHD. Examples of these agents include phthalates [11] and lead.[12] A number of other neurotoxicants (polychlorinated biphenyls, methylmercury, aresenic, toluene, manganese, chlorpyrifos, fluroide, tetrachloroethylene, dichlorodiphenyltrichloroethane, polybrominated diphenyl ethers) are also likely to impact the developing brain.[13] Some chemicals may even impair the developing nervous system across generations.[14] One study using mouse models found that prenatal nicotine exposure was linked to the transgenerational expression of an ADHD phenotype.[15]

Studies have also shown that second hand smoke exposure increased the severity of symptoms in preschoolers already diagnosed with ADHD.[16] Smoking during adolescence has also been associated with decreased attention scores that last into adulthood.[17] During the developmental phases, the brain and nervous system may be susceptible to a number of different risk factors and stresses. Along with the risks mentioned above, maternal stress and infection during gestation may play a role in the development of ADHD.[18] Studies have suggested that maternal stress may result in inflammation that may be associated with increased risk.[18] Other factors such as the use of alcohol,[19] marijuana [20] and cocaine [21] during gestation are also associated with the development of ADHD.

Medications are another important consideration. One study associated labetalol use during pregnancy with an increased risk of ADHD.[22] While another study found that acetaminophen use during pregnancy was associated with increased hospital diagnosis of Hyperkinetic Disorder (hazard ratio = 1.37; 95% CI, 1.19-1.59), increased ADHD medication use (hazard ratio = 1.29; 95% CI, 1.15-1.44) and increased symptoms of ADHD by age 7 (risk ratio = 1.13; 95% CI, 1.01-1.27).[23] Acetaminophen side effects were worse with increased maternal use during pregnancy and with use in more than 1 trimester.[23] There may be implications related to other medications that have not received adequate research is this area.

Health and Social Factors

Many factors including the ones discussed above can affect an individual's health. According to the 2013 health statistics for U.S children, ADHD is almost four times as prevalent when health is poor.[24] Along with physical health, social factors also play a role. For example, children from single-mother families are more likely to be diagnosed with ADHD (12% vs. 8%).[24] Parental marital problems may also have an impact. In a Nigerian study, a negative assessment of marriage by parents was associated with increased ADHD in their children (OR = 0.1; CI = [0.017, 0.567]).[25]

Use of Electronic Screens Use of Electronic Screens

The amount of time individuals spend using various screens, i.e. computers, television, etc, may have an impact on their ability to pay attention. This may result from promoting short snippets of information.[5] One study found that daily television exposure at 18 months of age was associated with hyperactivity and inattention at 30 months.[26] Problematic video game test scores were correlated with daily video game hours (r=0.47, P=.002) and inattention (r = 0.37, P = .01).[27] Another factor to consider, is that screen time may adversely affect sleep duration and latency.[28] Sleep restriction may cause impaired neurobehavioral function,[29] and 25-50% of parents of children with ADHD report sleep disorders, especially trouble staying or falling asleep.[30] As outlined thus far, a number of factors may potentially cause or aggravate ADHD symptoms. It is therefore essential that risk factors be minimized or eliminated. Along with this, a number of natural treatments may be utilized to reduce the risk of causative factors as well as support optimal physiologic function.


Treatments Nutrition and Diet
Nutrition and Diet

Diet is an essential component of health throughout life. Exclusive breastfeeding before the age of 6 months has been associated with decreased incidence of ADHD, whereas early introduction of bottle feeding may increase the risk.[31] In older individuals, there is evidence to suggest that elimination diets can improve ADHD symptoms, showing clear connections between diet and behaviour.[32] Preservatives, additives, and certain foods that may cause negative responses may be eliminated with these diets.[33] Proper food choices may also have benefit in treating comorbid physical complaints, sleeping problems [32] as well as potentially reducing inflammation,[34, 35] which, as mentioned above may all be aggravating factors in ADHD.

Sugar, as it relates to ADHD, has received a lot of discussion, and some studies have found decreased attention following high sugar intake.[33] A proposed mechanism of action is a rebound hypoglycemic effect resulting in decreased attention.[33] However, sugar in general does not appear to affect all individuals. One study found that the total intake of sugar did not affect ADHD symptoms, but when comparing simple sugar consumption from fruit, versus other sources, a significant association with ADHD was found, with a greater risk from sugars not consumed from fruits (P<0.05).[36] This same study also found foods high in vitamin C to be associated with decreased risk of ADHD (P<0.05).[36] p>

Diet may also be an important feature of detoxification, which may be beneficial based on the toxin associations discussed above. Recent research suggests that diet is linked to cellular health by modulating appropriate gene responses, cell apoptosis, and detoxification.[37] Detoxification may also be supported by improving digestive function through the utilization of probiotics and ensuring adequate viscous dietary fiber.[38] Supplementation with N-Acetyl cysteine, vitamins E, C and selenium may be used to reduce toxins by increasing glutathione levels.[39] Various blood and urine tests are available to measure toxin levels in the body.[40] However, no studies specifically measuring the effects of detoxification on ADHD were found, although one case report did indicate improvements with Attention Deficit Disorder.[41] Therefore, further research is required to explore the implications of diet and detoxification in ADHD.

Nutritional Supplements

A portion of the ADHD population may have nutrient deficiencies. Low zinc (Zn) levels have been associated with ADHD.[33] In some cases, when the Zn deficiencies are corrected, parent-teacher rated inattention improved as well as the effects of some stimulant medications.[33] Low iron (Fe), may also affect ADHD symptoms. One study found that inattentive ADHD patients have increased likelihood of Fe deficiency (P=0.02) and inattentive symptoms may improve with Fe supplementation (P=0.02).[42]

There is evidence to suggest that vitamin levels may also be deficient. Research indicates that vitamin D [43] and micronutrient [44] deficiencies are possible. Some individuals may even improve with omega 3 fatty acid supplements. For example, a meta-analysis consisting of 699 individuals with ADHD found a small but significant effect on ADHD with supplementation of omega 3 fatty acids.[45] More studies are needed to determine how these and other vitamin and nutritional supplements will impact ADHD.

Herbal Medicine and Acupuncture

Research regarding herbal medicine and acupuncture for the treatment of ADHD is also limited, although, some studies do suggest improvement. For example, Gingko Biloba may have a positive impact by increasing dopaminergic activity.[46] Some research suggests that Gingko Biloba may be able to improve core ADHD symptoms and quality of life with minimal side effects.[47] Preliminary acupuncture research suggests improved ADHD symptoms based on subjective measures and improved academic performance.[48] Acupuncture may also improve comorbid conditions such as insomnia.[49]


Exercise Exercise

Exercise has been shown to reduce the symptoms of ADHD, with improved neurophysiological parameters, motor skills and social behaviour.[50] It may also improve performance in reading and arithmetic.[51] A small single-arm design study, consisting of 9 children with ADHD, found improved symptoms with yoga practice and a worsening of symptoms when practice became less frequent.[52] This study indicates that consistency of exercise may be important. Other exercises such as aerobic activity [51] and Tai Chi [53] may also improve symptoms, along with spending time in more natural areas, such as a park versus down town.[54]


Conclusion

A number of factors may contribute to the development or aggravation of ADHD symptoms. Thus, it is very important to minimize these risk factors, which may be done by eating organically, avoiding illicit drug use, unnecessary medications, smoking, alcohol, minimizing screen time, etc. It is especially important to minimize toxin exposure during pregnancy. Research is lacking for a number of complementary and alternative therapies. However, studies do suggest that lifestyle, including proper nutrition and exercise, as well as spending time in nature are important. There may be added benefit from certain herbal and nutritional treatments and other therapies such as acupuncture.

When considering the benefits of exercise, it may be necessary to find activities that are enjoyable and thus desirable to be done long term. This may enable sustained benefits. Cultivating a lifestyle that incorporates a healthy diet, social life and exercise routine, as well as utilizing potentially beneficial treatments may improve symptoms in a number of individuals. This could potentially minimize the necessity of medications, as well as reduce the occurrence of ADHD in present and future generations.