Attention Deficit Hyperactivity Disorder (ADHD)
I dislike labels, and have deliberately steered clear of labels and “disorders” on this website, focussing instead on symptoms and their possible contributors, as well as solutions.
However, certain labels can be useful, and in the context of this website, can be helpful in synthesising information about root causes and solutions to a set of symptoms.
In this case, we are talking about ADHD, or Attention Deficit Hyperactivity Disorder. Symptoms can include poor concentration and attention, lack of focus (or conversely, hyper-focus), impulsivity, and hyperactivity.
I recently did an interview for The MindHealth360 Show with Dr. James Greenblatt, an integrative child and adolescent psychiatrist whose book “Finally Focused: The Breakthrough Natural Treatment Plan for ADHD That Restores Attention, Minimizes Hyperactivity, Helps Eliminate Drug Side Effects” offers a brilliant synopsis of ADHD and how to fix it.
Below is a summary of key points for those looking for safe, effective, and proven solutions to their, their clients, or their loved ones’ ADHD.
“ADHD is not a ‘behaviour or a discipline’ problem, but rather a medical disorder in which neurological, nutritional, genetic and environmental factors imbalance the brain, producing imbalanced behaviour.” – Dr. James Greenblatt
ADHD seems to be increasingly prevalent in our societieshttps://www.cdc.gov/ncbddd/adhd/timeline.html [accessed 14th October 2020].
This may be partly the result of better diagnostic tools and better recognition of the disorder, partly to our modern societies which are rife with toxins, sugars and processed foods, 24/7 connectivity, distractions and over-stimulation.
- In the US, according to the Center for Disease Control and Prevention (CDC):
- almost 10% of children ages 2 to 17, or just over 6M have been diagnosed with ADHDhttps://www.cdc.gov/ncbddd/adhd/data.html [accessed 7th October 2020]
- 8M adults have the disorder
- In the UK, according to the Royal College of Psychiatrists:
- around 3-6 in every 100 school-aged children have ADHD
- for about 1 in 7 children with ADHD, their ADHD will continue into adulthood
- about half of these children will have some problems as adults, although not full ADHD
- in children, boys are more commonly diagnosed than girls, whereas in adults, there are more equal numbers of men and women seen in clinicshttps://www.rcpsych.ac.uk/mental-health/problems-disorders/adhd-in-adults [accessed 14th October 2020]
Symptoms of ADHD
Children and adults with ADHD tend to be energetic, creative, intuitive, and passionate about what interests them. Many of them can hyper-focus in the right circumstances (eg: if they have deadlines) and produce brilliant work.
They tend to also have a need for new experiences and a willingness to take risks.
Their dreamy creativity and risk-taking can sometimes cause difficulties for personal relationships and productivity.
There are three main symptoms of ADHD, and depending on the type of ADHD, (inattentive vs hyperactive-impulsive or a combination of both) not all the symptoms may be present. The symptoms below describe ADHD in children and adolescents, but can also apply to adults:
- don’t listen even when spoken to directly
- have a tough time sticking with or completing tasks, whether it’s homework or a game
- disorganised and messy
- lose things often
- don’t pay attention to details and make a lot of careless mistakes
- don’t like to do things that require focus
- easily distracted
- fidget and squirm constantly
- always “on the go”
- can’t stay seated at school or at the dinner table
- run around or climb when it’s inappropriate
- talk all the time
- can’t play quietly
- blurt out answers before the question is finished
- can’t wait their turn
- interrupt or intrude when trying to have a conversation
- are irritable, angry or aggressive
- can’t delay short term pleasure for long term results
Consequences of untreated ADHD
Many children will naturally grow out of their ADHD as they get older. However, while they have it, their ADHD can impair their ability to learn, do well in school, and develop healthy relationships with their peers.
Without treatment (and the treatment can either be natural or pharmacological or both), ADHD can cause many long term issues which can negatively impact people’s lives, whether they are children, adolescents or adults.
- do poorly in school, with nearly 50% being suspended
- have more problems with their family and fewer friends
- be relentlessly criticised for their behaviour, and their self-esteem can plummet
- engage in risky behaviour
- use illegal drugs
- drive recklessly, and get into accidents
- have sex earlier
- 30% drop out of high school compared to 10% of non ADHD kids
- be inattentive and distractible
- find it hard to get organised and on track
- can do well in some areas at work (eg. they can be creative and entrepreneurial), but struggle in other areas
- be twice as likely to get separated or divorced from their spouses
- experience more anxiety and depression
- be more likely to be addicted to tobacco or illegal drugs
Root causes of ADHD
ADHD is diagnosed based on behaviour and symptoms. But in order to treat ADHD sustainably, we have to look at what may be causing it.
Integrative and functional medicine mental health practitioners use a combination of psychological and lifestyle-behavioural assessments, as well as biochemical lab testing to diagnose what may be at the root cause of someone’s mental health issues.
Biochemical lab testing
In the case of ADHD, Dr. Greenblatt recommends doing the following tests:
- genetic testing (especially for the MTHFR variant)
- nutritional deficiencies (especially for magnesium, lithium and zinc) and imbalances (for instance copper-zinc imbalance) through blood levels but also from hair mineral testing
- food intolerances (especially to gluten and dairy)
- kryptopyrroles (which can prevent absorption of the key nutrients zinc and B6)
- organic acid testing (to detect a wide range of metabolic imbalances including levels of HPHPA from gut bacteria c.difficile, which can create high levels of dopamine)
Factors that can cause ADHD
ADHD is partly a neurological disease, in which the brain and nervous system are affected.
Children with ADHD have areas of their brain that are, on average, smaller than those of non ADHD children. These areas control attention, impulsivity and executive function, or the ability to plan, organise, focus and complete a task.
The ADHD brain isn’t permanently smaller, it lags about 2 to 3 years behind normal development and eventually catches up. That’s one reason why ADHD symptoms tend to decrease or disappear in adolescence.
Brains of children with ADHD get less oxygen-rich blood flow, and are less able to utilise blood sugar for brain fuel. Their brain cells have a harder time getting the fuel they need for optimal functioning.
Children with ADHD tend to have different brain waves. 80 to 90% of ADHD children have more theta, the waves that slowly move through the brain when you’re dreamy, tired or lethargic, and less beta, the waves that zip rapidly through the brain when you are focused, alert and energised.
There is a certain biochemical footprint to ADHD characterised by:
- lower dopamine (the motivation, pleasure and reward neurotransmitter), hence why most ADHD medication boosts dopamine in the brain
- the fewer the dopamine receptors, the greater the inattention
- when dopamine is plentiful, you’re focused and you feel good
- when it’s not plentiful, you can feel demotivated, lethargic and lacking in focus and concentration
- lower serotonin (the happiness and contentment neurotransmitter)
- lower GABA (the calming neurotransmitter)
“Most people with ADHD have sluggish and underfed brain reward circuits, so much of everyday life feels routine and understimulating. To compensate they are often drawn to new and exciting experiences and get famously impatient and restless with the regimented structure that characterises our modern world” – Dr. Richard Friedman, Professor of Clinical Psychiatry at the Weill Cornell Medical College, NY.
ADHD has a strong genetic component. 70% to 80% of those diagnosed with ADHD have genetic drivers.Franke, B., Faraone, S. V., Asherson, P., Buitelaar, J., Bau, C. H., Ramos-Quiroga, J. A., Mick, E., Grevet, E. H., Johansson, S., Haavik, J., Lesch, K. P., Cormand, B., Reif, A., & International Multicentre persistent ADHD CollaboraTion (2012). The genetics of attention deficit/hyperactivity disorder in adults, a review. Molecular psychiatry, 17(10), 960–987. https://doi.org/10.1038/mp.2011.138, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3449233/ [accessed 14th October 2020]
Genetics and neurotransmitters
The main genes affected are those that control neurotransmitters, chemicals that relay messages from neuron to neuron.
The key neurotransmitters for ADHD are dopamine and norepinephrine, both neurotransmitters that control attention, ability to focus and a pleasurable sense of reward.
People with ADHD have fewer dopamine receptors, for genetic reasons, which means that they will be less able to process and enjoy dopamine.
For instance, a genetic variant called MTHFR prevents the smooth conversion of folic acid into L-methylfolate, thereby slowing the production of dopamine and serotonin. Serotonin is the happiness and contentment neurotransmitter, so not only will people with this genetic variant be at greater risk of lacking in focus, attention and motivation, but they may also feel less content.
The nutritional aspect of ADHD is often overlooked by conventional doctors, however it is essential to understanding and treating ADHD.
Well-nourished children have fewer symptoms of ADHD
Studies show that malnourished children have lower IQs, shorter attention spans, are more distractible, more restless, have poorer memories, worse school performance and behaviour, more aggression, poorer executive functioning with less ability to plan, organise and complete tasks, and more temper tantrums and crying as children.
Nutritional issues of children with ADHD
- 90% of children diagnosed with ADHD have a nerve-nourishing magnesium deficiency, and a majority of children in the US have a magnesium deficiency
- magnesium fuels ATP which powers every cell, and is essential for blood sugar regulation and the immune system
- magnesium plays a key role in the formation of neurotransmitters, especially dopamine and serotonin (for focus, motivation, pleasure and contentment)
- low magnesium can undercut the functioning of glutamate receptors, areas of brain cells that assist in the movement of neurotransmitters
- stress depletes the body of magnesium
- poor quality soil can reduce magnesium levels in food
B6 and Zinc:
Many children with ADHD have pyroluria, which causes a deficiency in B6 and zinc due to excess kryptopyroles
Many children with ADHD have food intolerances:
- especially to casein, the protein in dairy
- also to artificial additives in foods such as artificial colourings, flavourings and preservatives
People with ADHD also have difficulty absorbing certain amino acids from proteins, which are necessary to make key neurotransmitters such as dopamine and serotonin.
Blood sugar issues
Low blood sugar can lead to symptoms of ADHD
- ADHD brains metabolise glucose differently, and can lead to effects on adrenaline and noradrenaline
Toxic pollutants in the air, water, and food can contribute to ADHD
- there are higher levels of ADHD in children and young people who live in cities
- mothers exposed to air pollution during pregnancy raise the risk of ADHD in their child
- poorer children are twice as likely to have ADHDChoi, Y., Shin, J., Cho, K. H., & Park, E. C. (2017). Change in household income and risk for attention deficit hyperactivity disorder during childhood: A nationwide population-based cohort study. Journal of epidemiology, 27(2), 56–62. https://doi.org/10.1016/j.je.2016.09.004 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328727/[accessed 11th October 2020], which could be a combination of poor diet, but also more polluted living conditions
- children with higher urinary levels of BPA, the toxin found in plastics, have more ADHD
- children are more hyperactive when faced with challenging environmental factors
Stress and trauma, whether current or past, can contribute to ADHD
- Professor Stephen Porges, inventor of the Polyvagal Theory, sees a link between a child not feeling safe, and ADHD behaviour
- when a child or an adult has a neuroception of danger, possibly due to a dysregulated nervous system from past trauma or ACEs (Adverse Childhood Circumstances), this can manifest as ADHD behaviour
Overstimulation of our modern societies
24/7 connectivity, globalisation, information overload, stressful lifestyles, urbanisation and chronic busyness can all contribute to ADHD, or exacerbate existing conditions.
Solutions for ADHD
There are many natural solutions to ADHD, broken down for us by Dr. Greenblatt in his great book “Finally Focused: The Breakthrough Natural Treatment Plan for ADHD That Restores Attention, Minimizes Hyperactivity, Helps Eliminate Drug Side Effects”. If none of these are effective, the right medication can be very helpful.
Treated appropriately, the symptoms of ADHD can be vastly improved. According to Dr. Greenblatt, who has treated thousands of ADHD cases:
- attention will strengthen and steady
- distractions will seem less compelling
- restlessness will turn into restfulness, the ability o slow down and savour life rather than rushing from one thing to the next
Correct nutritional deficiencies
Correct magnesium deficiency:
- symptoms of restlessness, poor focus, irritability, sleep issues and anxiety can vanish after a month of supplementation with magnesium
- 200mg twice a day (glycinate, citrate or threonate)
- can reduce the side effects of ADHD medication such as irritability, agitation, anxiety, insomnia, facial tics and nail biting
- can improve hyperactivity, inattention, oppositional behaviour, and executive function
- can help to normalise brain waves
- magnesium supplementation takes 1 to 3 months to see real results
Correct copper/zinc imbalances:
- having the correct balance of zinc and copper is essential for a healthy brain and behaviour, and yet high numbers of ADHD children have high copper and low zinc
- excess copper
- copper helps make dopamine, however too much copper can lead to excess dopamine which then causes excess norepinephrine resulting in hyperactivity, agitation, irritability and aggression
- can block the production of serotonin, and trigger emotional, mental and behavioural problems such as depression and anxiety and psychosis
- the ADHD drug Ritalin won’t work if there is copper excess, and can make symptoms worse
- getting enough zinc is a must for a healthy brain
- zinc plays an essential role in the manufacture of proteins (the building blocks of nearly all cellular structures) and enzymes (the spark plugs that drive cellular activity)
- zinc also helps create neurotransmitters such as dopamine, norepinephrine, and serotonin
- zinc is essential for melatonin production
- zinc nourishes the entire brain, and ensures the stability of the outer covering (membrane) of neurons
- zinc balances brain waves
- what lowers zinc
- excess copper
- stress and high cortisol
- excessive exercise (loss of zinc in sweat)
- vegan and vegetarian diets
- BPA (plastic) and other toxins
- Supplementing zinc:
- zinc picolinate or glycinate
- 30mg twice a day
- 13 and under: 15mg twice a day
Correct iron deficiency
- ADHD has been shown to correlate with low iron and low ferritin
- low brain iron has been linked to sleep disorders, depression, bipolar, anxiety, autism, mental retardation
- iron plays a role in dopamine metabolism
- 15mg daily, but after getting iron levels checked to make sure there is no excess
Add brain foods
OPCs — oligomeric proanthocyanidins
- powerful plant pigments called polyphenols and flavonols, antioxidant compounds that plants produce to protect themselves from environmental harm
- green tea extract
- pine bark — Pycnogenol
- dark chocolate
- flavonols easily enter human cells, including brain cells
- help balance brain waves and restore attention
- regulate levels of norepinephrine and epinephrine, neurotransmitters that direct the flow of information within the brain
- irregular levels can undermine focus
- they limit the production of glutamate, an excitatory neurotransmitter that is toxic in large quantities
- slow the production and release of histamine, a neurotransmitter and inflammatory biochemical released during allergic reactions
- protect the fat-rich cells of the brain from lipid peroxidation, a kind of internal rust generated by renegade molecules called reactive oxygen species (ROS)
- strengthen the delicate blood brain barrier, keeping neurotoxins out
- improve blood flow to the brain, helping deliver crucial brain supporting nutrients
- can absorb and disarm metals that can harm the brain
Low dose nutritional lithium:
- What is it?
- a mineral commonly found in water and soil
- so soft you can cut it with a knife and so light that it floats on water
- nutritional lithium (lithium oretate or citrate) is not the same as high dose prescription lithium carbonate, the drug for bipolar disorder
- Benefits of nutritional lithium
- the closest thing to a brain tonic
- helps to ease irritability, anger and aggression in children with ADHD
- helps to reduce memory loss in seniors
- helps with addictions
- increases serotonin and dopamine
- lowers glutamate, which can damage neurons if levels are too high
- increases the action of MAO (monoamine oxidase) and enzyme that regulates neurotransmitters
- helps protect brain cells from excitotoxicity
- helps to activate neurotrophins (proteins that nourish and protect neurons) such as brain-derived neurotrophic factor (BDNF)
- can increase the amount of grey matter
- decreases neuroinflammation
- helps to move vitamin B12 and folate into brain cells
- Diagnosing the need for lithium
- even a distant relative with substance abuse, bipolar disorder, depression or suicide is a sign that the patient may need lithium
- many of those with ADHD are deficient in lithium, particularly those with symptoms of irritability, anger, and aggression
- hair mineral analysis
- avoid lithium asparate which is an excitotoxin that can trigger headaches and brain inflammation
- 1mg and 2mg a day to start, twice a day
Vitamin D helps with serotonin, dopamine and norepinephrine
- B6 is an essential precursor to the neurotransmitters dopamine and serotonin (P5P form is best)
- 50mg a day, though below age 13, 25mg per day
- folate is also an essential precursor to dopamine and serotonin
Get the right levels of fats
Omega 3 fatty acids:
- strengthen the outer layer (membrane) of brain cells and enhance intra-brain communication
- support neurons in making serotonin
- help maintain healthy dopamine receptors
- lower inflammation
- facilitate neurotransmission
- improve attention, focus, sleep, memory, and learning
- 1000 to 3000mg per day
- phosphatidylserine and phosphatidylcholine
- essential brain nourishment
- phosphatidylserine, 100mg 2x a day up to 300mg
Gamma-linoleic acid (GLA)
- omega 6 which has anti-inflammatory and brain healthy properties
- healthy cholesterol levels are essential to healthy brain function
- cholesterol should be above 130mg/dl
- cholesterol stabilises serotonin
- add lipase, an enzyme that helps digest cholesterol
Get the right amino acids
- eat protein to feed the brain, as we need the amino acids from protein to make the right neurotransmitters
- you can also supplement with these amino acids which are precursors to key neurotransmitters
- for dopamine: tyrosine, phenylalanine
- for serotonin: tryptophan
- for gaba and serotonin: l-theanine (100mg to 200mg 30 minutes before bed can help with sleep)
Correct food sensitivities and food allergies
- especially prevalent as a cause of ADHD among kids of 10 and younger
- casein, the protein from milk, and gluten, the protein from wheat, become casomorphine and gliadorphin, and attach to the opioid receptors in the brain
- allergens activate the immune system and increase inflammation, which can aggravate the symptoms of ADHD
- sugar increases dopamine, but can cause dopamine receptors to wear out, leading to tolerance, meaning that you need even more sugar for the same dopamine effect
- sugar lowers serotonin, dopamine and other neurotransmitters, because:
- it burns through B vitamins, which are necessary for the production of neurotransmitters
- it’s inflammatory which also hampers neurotransmitter production
Balance blood sugar
- add protein to any sugary meal or snack to help balance blood sugar
- ADHD brains do better with a steady supply of glucose to the brain
- Prevents the breakdown of dopamine and norepinephrine
As we have seen in causes of ADHD, some ADHD behaviour can be associated with a neuroception of danger based on a dysregulated nervous system, which can often come from trauma and adverse childhood experiences.
Mind-body therapies can be especially helpful for treating underlying trauma and ACEs (Adverse Childhood Experiences) that could be contributing to ADHD behaviour, as well as other therapies which can help to rebalance the nervous system.
Detoxify the environment
Reduce exposure to chemical toxins, and detoxify, to reduce chemicals which could be impacting the brains and behaviour of ADHD children and adults.
Create safe spaces and relationships
Create and maintain physically and psychologically safe spaces for learning and living for children and adults, which should reduce ADHD behaviours. This means that schools and homes should be geared towards making children feel safe, focussing on positive reward rather than punishment, and that harmonious relationships at home, at school and at work should be cultivated as a priority.
Optimise home, school and work environments
Optimising home, work and education spaces which are physically and emotionally safe, quiet (as people with ADHD can be hyper-sensitive to noise), stimulating without being over-stimulating, clean, non-toxic (no moulds, pesticides, herbicides, air pollution), peaceful and harmonious, not too hot, nor too cold. In summary, environments that are SAFE, and encourage neuroception of safety will be conducive to better learning.
Spend time disconnecting from devices, social media, and other sources of stimulation and distraction.
Read a book, take a walk outside, meditate, spend some time just letting yourself daydream or be bored.
Connect with nature and natural light
Spend more time in nature, walking, exercising, gardening, playing.
In order to sustainably improve ADHD, it is essential to heal the gut, and make sure that there are no chronic bacterial imbalances, toxins, fungi, and sources of inflammation that could be impacting the brain and behaviour.
Correct an excess of HPHPA:
- a byproduct of metabolism of the intestinal bacteria clostridia difficile
- can trigger dopamine excess in the brain causing hyperactivity, impulsivity and aggression
- excess dopamine can cause oxidation in neurons, using up glutathione, one of our main detoxifying and antioxidant agents, thus reducing our ability to detoxify and neutralise other toxins and free radicals
Correct candida albicans:
Excess toxic metabolites produced by candida can overwhelm the system, get into the brain and dampen down activity in the prefrontal lobes, reducing the executive function (responsible for functions such as planning, organisation, control) of the brain. In order to prevent this from happening:
- reduce sugar consumption, which feeds the candida
- introduce probiotics
- if you are diagnosed with candida, take anti fungals such as garlic, oregano oil, grapefruit seed extract, and coconut oil
Probiotics can help with:
- toning the vagus nerve, which is essential to good gut-brain communication and neuro-endocrine balance
- hormone regulation
- neurotransmitter regulation (since a majority of neurotransmitters are made in the gut)
- reducing inflammation
- getting rid of clostridia difficile which can produce HPHPA
- getting rid of candida albicans
- 10 to 30 Billion units per day
Digestive enzymes can help to break down food so that it is better absorbed. This can help absorb the right nutrients and cofactors, but also can help reduce inflammation and gut issues caused by poorly digested foods.
- DPP-IV is an enzyme that breaks down gluten and casein
- 2 to 4 capsules at every meal containing gluten and casein if there is an intolerance to these substances and elimination is not possible
Children and adults with ADHD can be prone to sleep issues, and yet sleep is important and healing to the brain.
Children with ADHD thrive on regular, appropriate exercise, which can enhance their ability to focus, concentrate and sit still when necessary.
Regular exercise boosts BDNF (brain-derived neurotrophic factor) which is essential for brain plasticity and regeneration), and serotonin (the happy, calm neurotransmitter) and dopamine (for focus and motivation), as well as feel-good endorphins.
While it may seem paradoxical to ask a child, or even an adult, with ADHD to meditate, mindfulness meditation has been shown to improve attention, focus and concentration.
It has also been shown to improve connectivity in the default mode network, which is less robust in people with ADHD.
Start slowly, with a few minutes each day, and gradually work up to longer periods of time.
Neurofeedback for ADHD has been shown in some studies to be just as effective as medication, according to Dr. Greenblatt.
Once natural methods have been tried, and testing carried out for food intolerances, genetic variants, nutritional deficiencies, and any imbalances have been addressed, if symptoms of ADHD are still debilitating, medication can be very helpful and effective.
Dr. Greenblatt’s book “Finally Focused: The Breakthrough Natural Treatment Plan for ADHD That Restores Attention, Minimizes Hyperactivity, Helps Eliminate Drug Side Effects” goes through medication options and is a helpful guide in navigating those versus natural treatments.
According to Dr. Greenblatt, children with ADHD respond better to:
- stress relief and relaxation techniques (which fits with Professor Porges’ view that ADHD behaviours can manifest when we do not feel safe)
- respectful parenting and teaching
- rewards and positive feedback
- encouragement and soft parenting rather than pushy parenting and tiger-mom styles