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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by ConRon on January 29, 2007, at 18:11:40
Hi Larry,
I noticed you are very knowledgable on the subject of alternative meds. and I was wondering what you would recommend for a ADHD/Anxiety 11 yr. old boy who has taken everything from Adderal-Lexapro. Any info is much appreciated, Thanks
Posted by Larry Hoover on January 30, 2007, at 8:10:32
In reply to Asking Larry Hoover, posted by ConRon on January 29, 2007, at 18:11:40
> Hi Larry,
>
> I noticed you are very knowledgable on the subject of alternative meds. and I was wondering what you would recommend for a ADHD/Anxiety 11 yr. old boy who has taken everything from Adderal-Lexapro. Any info is much appreciated, ThanksI am humbled when people ask me such important questions. I'll do my best to help. My son has ADHD, so I've kept up with the research.
There are three distint, but interactive, realms of functional nutrient deficiency that are highly correlated with ADHD spectrum disorders. The individual symptoms may be a guide which would focus on specific nutrients, but I believe that the following nutrients are central to treatment.
Long-chain Omega-3 fatty acids:
Both social factors and genetic factors converge here. Since about 1900, there has been a dramatic shift in Western diets towards the omega-6 fatty acids from the omega-3s, predominately from the substitution of vegetable oil-based products for e.g. butter and lard, and the shift from range-fed meat animals to confinement and grain rations. This has resulted in something like a 20- to 30- fold shift in the ratio of omega-6 to omega-3 intake in the typical Western diet. In ADHD, this is compounded by genetic factors which reduce the ability to absorb and utilize long-chain polyunsaturated fatty acids. Therefore, fish oil supplements are essential.Only fish oil supplies the key long-chain omega-3s known as EPA and DHA. Vegetable oil sources of omega-3 only provide the shorter fatty acid known as alpha-linolenic acid (ALNA). Most ADHD subjects have reduced capacity to elongate and desaturate, which is required if the body must synthesize its own EPA and DHA from ALNA. Fish oil supplies these fatty acids ready-made.
Dosage should be fairly high. Studies have used up to 15 grams a day, for ADHD. That might exceed your son's tolerance, but the inference is to get that intake substantially increased, by no less than 5 grams per day. Always take fish oil with a large meal, and if possible, with a meal that contains other sources of fat, to enhance uptake. Polyunsaturated fatty acids are at risk of oxidation in the body, so a vitamin E supp is a good idea, with the fish oil. Try to get a mixed tocopherol blend (i.e. one that contains all the tocopherols, not just alpha-tocopherol), and dose at 400-1000 mg. Vitamin C is synergistic with E, so I'd recommend 1000 mg/day.
High protein, low carb:
There is fairly robust evidence that ADHD subjects do not process protein effeciently. That leads to disturbance in a number of realms, including neurotransmitter synthesis, and enzyme production. Also, many ADHD subjects demonstrate sensitivity to sugar (which is enzyme-related). More stable blood glucose levels can be produced by relying on a diet that is heavy in protein, and low glycemic index carbs (i.e. complex carbs). That means something tending towards the ideas in the Zone diet, but it need not be so radical. Something more like the Paleo diet: http://www.paleodiet.com/ If you adopt some of these principles, you'd almost automatically reduce exposure to food additives, which also may be a problem. The simple act of providing a high-protein/low-carb breakfast has been shown to improve classroom attentiveness in ADHD.Minerals:
Two specific minerals are very important for ADHD treatment, magnesium and zinc. Not surprisingly, the typical Western diet is already deficient in these minerals, but ADHD subjects stand out from their peers, demonstrating significantly reduced blood levels of these two minerals in comparison to their already deficient "normal" comparator groups.Magnesium may be especially important to your son, because of the comorbid anxiety (also responsive to magnesium supplementation). That would be especially true of your son exhibits thirst, has asthma, or skin problems such as excema.
Magnesium is a cofactor for numerous enzymes and receptors, generally enhancing their ability to do their job. As an example, the GABA receptor, responsible to a large degree for calming influences, requires magnesium to work properly.
The trick with magnesium is to get the dose right, and to use the right sort of supplement. Taking into account body size, your son should probably benefit from 200-300 mg/day, elemental magnesium. Magnesium may cause diarrhea, but splitting the dose over the course of the day, and taking it with meals, should reduce that likelihood. Stay away from magnesium oxide, and use any other product. I like magnesium citrate, myself.
In one particular study, the combination of magnesium and B6 produced dramatic improvements in attentiveness and reductions in irritability. Doses were matched with body weight using the following formula: 6 mg/kg/d Mg, 0.6 mg/kg/d vit-B6.
Zinc may be a critical supplement for your son. The fact that stimulants didn't work may be a very important sign. Stimulant response in ADHD is proportional to blood zinc levels, in a linear relationship. Non-response to e.g. Ritalin could be caused by inborn problems handling zinc. Zinc is a critical component of many enzymes, including those responsible for neurotransmitter synthesis (from protein), and fatty acid metabolism. It also influences the senses of smell and taste.
The studies I have seen have generally supplied between 15 and 50 mg of elemental zinc per day, producing significant reduction in ADHD symptoms. I think 50 mg is into the potentially adverse dosage range, as zinc intake inhibits copper uptake......so I'd go for 30 mg/day, to be on the safe side.
If you can find a multi-vitamin that supplies this amount of zinc, then you'd also be ensuring adequate supply of a number of other minerals and especially the B-vitamins. Here are a couple of decent summaries of nutritional therapy for ADHD.
http://www.healing-arts.org/children/ADHD/nutritional.htm
http://www.accessmylibrary.com/coms2/summary_0286-7985984_ITM
Some practitioners subdivide ADHD into categories, and target treatments specific to those categories. The strongest proponent of these categorizations is Dr. Amen, who provides an online test, which can be completed by either the subject himself, or a parent.
It's been a while since I did the test myself, but I recall that the results show tendencies in four categories of ADHD symptoms, and suggests specific therapies for each category. You may find that it is useful to read his recommendations.
http://www.brainplace.com/ac/tests/add_test1.php
If you have more questions, feel free to post them here, or babblemail me.
Take care,
Lar
Posted by laima on January 30, 2007, at 8:32:30
In reply to Re: Asking Larry Hoover » ConRon, posted by Larry Hoover on January 30, 2007, at 8:10:32
What an awsome overview! I'm going to study it myself.
Posted by ConRon on January 30, 2007, at 15:49:31
In reply to Re: Asking Larry Hoover » ConRon, posted by Larry Hoover on January 30, 2007, at 8:10:32
Wow Larry Im impressed!! Thank you for all the advice. I have my list to take to the vitamin store. What do you think of GNC?
My son currently kinda eats lo-carb and not really intentionally he just doesn't care for hi-carb foods. He does have a few skin conditions, one being extremely dry skin in the winter and he also has pigment loss on one of his legs, has not yet traveled to other parts of the body so far (thank god)
I have often thought he could have a absorbption problem because he is soooo thin. He eats pretty good, not enough veggies, for sure...and he is very pale. I recently started giving him B-12 and a multivitamin with iron just in case it was an iron defiency and he became very hyper and one of his teachers asked me to stop giving it to him..lol
Well thanks for letting me pick your brain,
A concerned parent
Posted by Larry Hoover on January 31, 2007, at 11:51:02
In reply to Re: Asking Larry Hoover, posted by ConRon on January 30, 2007, at 15:49:31
> Wow Larry Im impressed!! Thank you for all the advice.
You're very welcome. It's probably best to start at the lowest doses practical, and work up over time to the targets I mentioned, if the supplements you obtain permit that.
> I have my list to take to the vitamin store. What do you think of GNC?
I don't often go to GNC. Their stuff is high quality, I believe, but the prices are also high. I got the distinct impression that their staff works on commission, which directs them to make sales rather than optimize advice. That's just my opinion.
> My son currently kinda eats lo-carb and not really intentionally he just doesn't care for hi-carb foods.
I strongly believe that intuition is not a fluke. I think your son is already developing the adaptive skills needed to manage life.
> He does have a few skin conditions, one being extremely dry skin in the winter and he also has pigment loss on one of his legs, has not yet traveled to other parts of the body so far (thank god)
The dry skin could be a sign of essential fatty acid deficiency. The vitiligo is not something we don't fully understand. http://en.wikipedia.org/wiki/Vitiligo
> I have often thought he could have a absorbption problem because he is soooo thin.
It is quite possible. The nutrient deficiencies tend to progress to become vicious circles. For example, one of the causes of vitamin B12 malabsorption is vitamin B12 deficiency. The same goes for minerals such as zinc.
Absorption issues can sometimes be improved by using probiotics. The microbes which colonize our guts are more than just neutral hitch-hikers. Their metabolic processes improve digestion and assimilation, both. In some cases, active forms of vitamins are produced from provitamin precursors found in food. The best probiotic I've ever used is Kirkman Laboratory's "Pro Bio Gold":
http://www.kirkmanlabs.com/products/probiotics/pro_bio/H_PROBIO_Gold_C_60_Spec042.htmlIt's expensive, but worth every penny.
> He eats pretty good, not enough veggies, for sure...and he is very pale. I recently started giving him B-12 and a multivitamin with iron just in case it was an iron defiency and he became very hyper and one of his teachers asked me to stop giving it to him..lol
Now, here's one of the issues that crops up when getting involved in nutrient supps.....the tendency is to try more than one change at the same time, and it confounds identification of what nutrient does just what. Was the hyper due to B12? Iron? The multi? The lot, taken together? Just a rhetorical inquiry, but you can see the difficulties that need to be addressed. It takes time. It takes intuition. It takes dedication. But, I strongly believe that some people simply need more nutrient intake than the RDA suggests. Not everyone lies at the median intake threshold for nonsufficiency. What about the rest of the normal curve, lying 1, 2, or 3 or more standard deviations from the mean? What intake is sufficient to overcome factors such as poor uptake (intake does not equal uptake), disordered intestinal motility, genetic defects in transporter proteins, excessive excretion in bile or urine, etc. etc.
> Well thanks for letting me pick your brain,
> A concerned parentThanks for picking my brain.
Lar
Posted by ConRon on January 31, 2007, at 20:35:40
In reply to Re: Asking Larry Hoover » ConRon, posted by Larry Hoover on January 31, 2007, at 11:51:02
Not sure exactly which vitamin was making him hyper because he was taking multi one day and B-12 the next. I didnt want to give him both at the same time just in case one of them didnt agree with him. But I think it may have been the multi vitamin, because it had alot of different B vitamins in it. Multi had iron also. So I have continued giving the B-12, but only a quarter pill just in case. I was also increasing his Lexapro to 5mg. and that didnt go so well.I noticed that had alot to do with the hyper activity. He's been on it for almost 3 months and Ive seen "some" benefits. In the last few days I have brought him back down to 2.5 mg. and things are much better. I purchased the vitamins today from IHerb and they should be here soon (they are quick) So Ill give them a try.
What Ive noticed with him is he doesnt react well to meds. that are stimulants. He reacts better to things that are calming so I'm hoping the magnesium will do the trick, Thanks
Ps. tell me of things you have tried that are good, and the things that have failed
ConRon
Posted by sregan on February 28, 2007, at 14:03:07
In reply to Re: Asking Larry Hoover, posted by ConRon on January 31, 2007, at 20:35:40
Most cases I've heard of ADD where the parent as changed the kids diet have been very successful. Google: "attention deficit" "food additives"
as of today you'll get 77,900 links.To blame are primarily food additives especially colorings. Secondly keep a watch for msg (or any of it's hidden terms see http://www.msgmyth.com/hidename.htm) and aspartame both are "excitatory" toxins. Aspartame is being discretely added to things that are already sweet like chewing gum. It's hard to find any that doesn't have aspartame.
A list of items that contain msg: http://www.msgtruth.com/avoid.htm
Shawn
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