Children are society's most precious resource. Yet millions of children in the U.S. and other countries are being fed an addictive, narcotic drug. The drug is Ritalin® (methylphenidate). Though officially classified a narcotic, it is prescribed to 70 percent of children diagnosed with ADHD (Attention Deficit/Hyperactivity Disorder). It acts on the brain with slower onset but almost identically to cocaine and amphetamines. The Ritalin story is one of the worst health scandals in recent times, moreso because there is a more effective and safer alternative. This is total health management of ADHD.
ADHD is the most common behavioral disorder in children, and often is accompanied by learning disability, obsessive-compulsive disorder, oppositional conduct, depression, or more rarely Tourette's Syndrome and other “tic” disorders. ADHD is being diagnosed with increasing frequency—in some school districts 15%-18% of the kids are officially ADHD. The diagnosis is difficult to make with certainty, and some experienced practitioners believe many kids are being misdiagnosed. Children maintained on Ritalin may not show consistent academic improvement, and are at increased risk of becoming drug abusers and juvenile delinquents.
Ritalin has severe adverse side effects, including nervousness, agitation, anxiety, panic; paranoid delusions, psychosis, hallucinations; withdrawal, disorganization; aggressiveness, assaultiveness. Recently, further controversy was generated by findings that Ritalin causes cancer in mice. In a letter to the U.S. Government, the nonprofit Center for Science in the Public Interest (CSPI) said “it is critical that a potentially carcinogenic drug (Ritalin) that is used by a large number of children over many months or even years be well tested and found to be appropriately safe...” Prominent cancer researchers and dietary experts joined with CSPI to demand exploration of alternatives to Ritalin.
ADHD has multiple contributory factors. There definitely is a genetic component, but this is unlikely to be sufficient to trigger the symptoms. Adverse responses to food additives and intolerances to foods; sensitivities to environmental chemicals, molds, and fungi; and exposures to toxins that damage the nervous system, such as heavy metals and pollutant chemicals, all are likely contributors. Physicians with wholistic/integrative practices say that pretty much all the ADHD cases they see benefit to some degree when these factors are treated. These practitioners are pioneering what I call total health management of the child with ADHD.
The total health strategy against ADHD means cleaning up the child's foods, air , water, and school and home environment. All sorts of allergic. toxic, and intolerance reactions can mimic the symptoms of ADHD in the afflicted child. Doris Rapp, MD, is a foremost authority on environmental illness (EI). She has documented the responses children can display in response to chemicals, molds, or just dust present in their everyday environment. Commonly their symptoms include hyperactivity, and impulsivity or loss of self-control.
The school environment is a major contributor to EI. In her comprehensive book Is This Your Child's World? (Bantam Books, 1996), Dr. Rapp stated that one-third of all U.S. schools need extensive repair and replacement, due to significant contamination with lead, asbestos, radon, leaking underground storage tanks, or poor plumbing, sewage, termites, ventilation, or structural inadequacies. In the contaminated classroom environment a child can quickly become tired and irritable, and suddenly seem incapable of learning. The child “can feel confused, perplexed, bewildered, and depressed, when for no apparent reason, they suddenly become irritable, moody, angry, sad, aggressive, vulgar, or can't think clearly” (p. 20, in Is This your Child's World?).
The adverse effects of the contaminated school environment may not fully show until after the child gets home. This can cause confusion about the source(s) of the offending exposures. But the home may have just as many contaminants as does the school.
The parent is an indispensable participant in the total health management of ADHD. Dr. Rapp has a “Big Five” list of symptoms that parents will find surprisingly effective at pinpointing an EI response. These are: 1. How does the child feel, behave, and remember? 2. How does the child's appearance change? 3. Is there any handwriting or drawing change? 4. Does asthma or other breathing problem appear? 5. Is there a change in the pulse rate or rhythm (especially a sudden 20-point increase in the rate)?
Total health management of ADHD also means eliminating unsuitable foods. Food intolerance reactions can remarkably mimic ADHD. In the 1970s Dr. Ben Feingold found that up to 50 percent of hyperactive children were sensitive to food additives (artificial food colors, flavorings, and preservatives) or to salicylates that occur naturally in some foods. Using diets that eliminated these, he achieved improvements in half the 1,200 children he studied. Double-blind studies confirmed this approach has value with ADHD children; but rarely will it eliminate all the ADHD symptoms. Allergies to foods themselves—corn, wheat, milk, soy, oranges, eggs, or chocolate are notorious offenders—also must be identified and eliminated. Double-blind studies suggest three-quarters of ADHD children respond favorably to food elimination diets.
Total health management of ADHD must lower the body burden of toxic metals and organic pollutants. These are linked to abnormal behavior, perception, cognition, and motor ability in children. Exposures to lead, arsenic, aluminum, mercury, or cadmium often causes attentional deficits, emotional lability, and behavioral reactivity. Lead has no safe threshold: blood levels as low as 10 millionths of a gram per 100 cc of blood are linked to psycho-behavioral deficits, and in the U.S.A. more than 3 million children test at this level. Lead can also synergize with aluminum, mercury, arsenic, or cadmium, and removing it by chelation therapy can significantly improve hyperactivity, impulsivity, conduct problems, and learning problems.
The entire planetary environment may now be partly to blame for ADHD. Persistent organic pollutants (POPs) are everywhere, including pesticides, herbicides, and fumigants, and myriad aromatic and aliphatic solvents. Children's brains are highly susceptible to these toxins during critical periods of their development, whatever the exposure levels. Chlorinated and brominated hydrocarbon, organophosphate, or carbamate pesticides are directly brain-toxic; their so-called “inert” ingredients such as benzene, formaldehyde, and petroleum distillates actually are anything but inert.
Damage to the thyroid gland is clearly connected with childhood brain damage. Thyroid hormones regulate brain maturation, and a link between poor thyroid function in the mother during pregnancy and diminished mental function in the offspring has been recognized for more than 100 years. A large study published in 1999 specifically confirmed attentional and leaning damage in such children. Children with ADHD have a 5 times higher occurrence of a rare condition called generalized resistance to thyroid hormone, or GRTH. Conversely, in children with GRTH attentional function is abnormal, and half this population have ADHD.
Synthetic chemicals released into the environment by design, that is pesticides, herbicides, and industrial chemicals are the main suspect thyrotoxins. Among 77 proven thyrotoxins are the most widespread POPs: the PCBs (Polychlorinated Biphenyls) dioxins, furans, chlorophenols, chlorobenzenes, phenols, and related substances, all commonly present in mother's milk around the globe. Nor does the mother's thyroid have to be severely damaged—clinically asymptomatic thyroid hypofunction in the mother is sufficient to result in brain damage to the child.
The ADHD child must be protected from potentially toxic foods, such as deep-fried stuff in which the essential fatty acids are oxidized to free radicals, and fruits or vegetables heavily laced with pesticides. One of the subtle toxins in foods is sugar (sucrose, refined). Over-consumption of refined sugar can make a marked contribution to hyperactive, aggressive, and destructive behavior. In one large study it was found that 74 percent of hyperactive children studied had abnormal glucose tolerance.
Another facet of the total health management of ADHD is correction of nutritional deficiencies. Virtually any nutrient deficiency can impair brain function, and the modern diet is infiltrated by “fast foods” which lack nutrient content. Assessment of ADHD children often reveals nutrient deficiencies or imbalances which when corrected, result in considerable behavioral and academic improvement. In ADHD, supplementation with iron, magnesium, zinc, and other minerals, B6 and other B vitamins, vitamin C and other antioxidants such as flavonoids, omega-3 and omega-6 essential fatty acids, and the phospholipid PS (phosphatidylserine) all can ameliorate ADHD symptoms.
The essential fatty acids, which are oily, vitamin-like nutrients, have shown considerable promise in ADHD. The two main classes—omega-3 and omega-6—are both necessary for overall health. The longer-chain, 20- and 22-carbon species of both classes are crucial for brain development, but for infants in Westernized countries DHA (docosahexaenoic acid, 22-carbon, omega-3) seems to play a pivotal role in children with “hyperactivity.”
DHA is essential to brain development, and is enriched throughout the entire brain cortex. In several studies hyperactive children were found to have significantly lower blood levels of DHA, and learning disabilities were linked to DHA deficiency. Although the single decisive study has not yet been done, every indication from the research completed to date is that correction of DHA deficiency should benefit ADHD. EFA balance is important, and DHA administered together with GLA (gamma-linolenic acid, omega-6) might be even more effective. Incidentally, DHA deficiency also is linked to depression.
The EFA are structurally and functionally linked with the phospholipid substances that make up the bulk of the cells' membrane systems. The phospholipids and the essential fatty acids are joined together in complex molecules within the cell membranes. The phospholipid PS (phosphatidylserine) is a building block for key nerve cell membranes deeply involved in production, packaging, and functioning of the brain's chemical transmitters. Poor functioning of dopamine-dependent pathways is strongly implicated in ADHD. I collaborated in a study with Carol Ann Ryser, MD, in which PS supplementation benefited greater than 90 percent of her ADHD cases. At intakes of 200-300 mg/day of PS for up to 4 months, in some children the results were remarkable. PS enhances the action of the chemical transmitter dopamine, and PS and DHA are especially closely linked in the brain.
Other nutrients also benefit ADHD. Dimethylaminethanol (DMAE) occurs naturally in the brain, and has been used with moderate success against ADHD. Anecdotal reports are circulating on the Internet, that bioflavonoids (oligomeric proanthocyanidins or OPCs), which have potent antioxidant activity, benefit ADHD. These flavonoids are safe for kids to take, have potent circulatory effects and may help enhance blood delivery of nutrients to the brain. I am now convinced that dietary supplementation with DHA and GLA, PS, DMAE, bioflavonoids, and other nutrients to children with ADHD will eventually make Ritalin irrelevant.
Physicians who practice total health management against ADHD take generally similar approaches. They organize dietary revision: removal of food additives, sensitizing foods, and sugar (sucrose) from the diet invariably results in some degree of improvement. They test for and correct nutrient deficiencies. They do thorough assessment for allergies and intolerances to foods and chemicals. The toxic burden of metals and organics is assessed and corrected. Many ADHD kids have intestinal bacterial imbalances (“dysbioses”), particularly from antibiotic overuse, as from treatment for ear infections which are a proven risk factor for ADHD. Here supplementation with probiotic bacteria is helpful, and Candida and other yeasts must be eliminated using medications where necessary.
After 3 to 6 months of testing, intervening, and retesting, following this strategy almost 100 percent of ADHD are markedly improved. For symptoms not satisfactorily improved, medication may then be considered: low doses at first, titrated upward as necessary to complement the benefits from the other interventions. The responsible physician should turn to medication only after the non-pharmacologic approaches have been thoroughly explored.
Unfortunately, the current norm for ADHD management is to do a minimal psychological assessment, then prescribe Ritalin®. Some physicians may be prescribing Ritalin as a substitute for practicing good medicine, including the safer and more effective options discussed above. Ritalin should at best be the treatment of last resort. For the vast majority of children who truly have ADHD (or any other health problem), total health management is the key.