Q and A

Help for ADHD

My 9-year-old son was “diagnosed” with ADD last year. I have some reservations about the diagnosis to begin with because no tests were done and the diagnosis was based on nothing more than the doctor talking to me. My son was placed first on Concerta, then Metadate and most recently we have been told he is being switched to Ritalin. The Metadate does not appear to be having any noticeable effect any more, but I am far from convinced that changing drugs again is really the right way to go. He is easily distractible, but he has never had any of the really serious symptoms and disruptive behavior that I have read about in researching this condition. I have heard that omega-3 fatty acids have shown some promise, as well as calcium/magnesium and behavior modification. I have not found any conclusive studies about herbs. Do you have any information or suggestions that would help me?
D.B.
Culpeper, Virginia

Khalsa responds: Your story is, unfortunately, all too familiar. Attention deficit diagnosis rates are rising, but it is unclear whether this is just the result of doctors becoming more aware of the disorder and its diagnosis and management.

This disorder is technically called Attention Deficit/Hyperactivity Disorder (ADHD). Attention Deficit Disorder (ADD) is an outdated term. In common discourse, ADD and ADHD are used interchangeably.

It is estimated that approximately 2 million U.S. children have ADHD — between 3 and 5 percent of kids. The main features of ADHD are inattention, hyperactivity and impulsivity. Impulsiveness and hyperactivity usually precede inattention, which may not come forward for a year or more after the initial symptoms appear.

Symptoms may vary in different settings, depending on the child’s self-control and the circumstances. One who “can’t sit still” or is disruptive will be obvious in school, but the inattentive daydreamer may not be noticed. The impulsive child who acts before thinking may be labeled a “discipline problem,” while the passive child may merely seem unmotivated. Both may have different reflections of ADHD.

All children are sometimes restless, impulsive and sometimes daydream the time away, all of which is normal and healthy. When the child’s behaviors or mental states begin to affect performance in school, social relationships or behavior at home, it may meet the threshold for an ADHD diagnosis. ADHD is not easy to diagnose. This is particularly the case when inattentiveness is the primary symptom, as it seems to be in your son’s case. Professionals recognize three subtypes — hyperactive/impulsive, inattentive and combined. Obviously, this is just a spectrum, and diagnosis is quite subjective. A diagnosis is based on a checklist of symptoms from DSM-IV, the official diagnostic manual. To be ADHD, the behavior must be demonstrated to a degree that is inappropriate for the person’s age, appear before age 7, continue for at least six months and create a real handicap in at least two areas of the person’s life.

Sometimes, in the trenches, ADHD is diagnosed rather casually. Often, we are in the area of nothing ventured, nothing gained. It’s thought that a trial of a medication can’t hurt, and if it helps, we have a solution. It’s a “diagnosis by drug” trial.

One of the first important things is to gather information that will rule out other possible causes. Other possible causes of similar behavior include sudden life changes — a family death, parents’ divorce, parent’s job loss; undetected seizures; middle ear infection; intermittent hearing problems; vision and visual perception problems; brain functioning disorders; learning disability; and anxiety or depression.

The drugs you mention actually are all the same chemical — the stimulant methylphenidate, or Ritalin. The basic form requires three-times-a-day dosing, and creates a blood level spike soon after each dose, which can be good for a kid who needs a higher dose early in the morning. Concerta is methylphenidate in a long-lasting, once-daily tablet. Metadate CD is methyl- phenidate in immediate release beads that give 30 percent of the dose immediately, with the other 70 percent of the dose released continuously over the next 12 hours or so.

Most of ADHD is probably genetic, with a few known environmental risk factors, including alcohol, smoking, brain injury and lead. Natural remedies support the affected systems. A holistic pediatrician, Lendon Smith, M.D., has written some good material on the rainbow of additional environmental and genetic risk factors.

The puzzle, though, is that, if ADHD is a neurological disorder, why can all the children and adults attend to computer games and the like for long periods, when they have attention struggles with less-enjoyable tasks? They can attend very well to tasks they enjoy, but have difficulty with tasks they dislike, much like the rest of us — ADHD kids are just more extreme. Perhaps it’s really more about motivation. That’s how behavior modification therapy can help, as you suggest.

I have had very good successes in looking at food allergies. See an alternative practitioner, test for allergies and eliminate the offending foods. A serious trial of allergy elimination usually produces remarkable results. Smith told me that removing wheat and cow’s milk (easier said than done) produced some degree of improvement, from small to great, in 95 percent of his ADHD patients. One child I saw, who had the worst hyperactivity I have ever seen, was essentially cured by removing all wheat from his diet.

One way to accomplish this at home is a “few-foods diet.” Start by eliminating wheat, eggs, milk, chocolate, corn, soy, caffeine, MSG, artificial colorings, flavorings and preservatives. Add back one food at a time for up to one week each. Keep a careful food record, including any reaction to the food, such as itching or a scratchy throat. If the child has any suspicious response, eliminate that food category completely, at least until it can be evaluated further.

Omega-3 oils do show promise. In one recent study, 20 teenagers aged 12 to 15 with moderate to severe ADHD took omega-3 oils for three months. Inattentiveness fell from an average of 94 percent at the start of the trial to 17 percent; impulsivity, with an initial rating of 89 percent, fell to 28 percent.

Zinc is important for brain function, and is used in treatments for anorexia and bipolar disorders. Zinc deficiency has been linked to ADHD, and zinc therapy is showing promise in treating ADHD, especially inattentive symptoms, and in enhancing the effects of stimulant treatment.

One 2004 study concluded that ADHD may benefit from iron supplementation because low iron stores contribute to the syndrome.

Have hope, especially for this apparently mild case. I have seen the lives of entire families restored with some serious investigation and detailed treatment of ADHD, using natural methods.

Willard responds: This question is close to my heart, as three of my four children also were diagnosed with ADHD. I have specialized in this condition since the early 1990s. I have worked with several thousand ADHD children and adults.

An important thing we have learned about this condition is that when the person feels confused and uncomfortable inside, they will create a scene outside themselves as a distraction from their inner confusion or will “space out” into their own world.

As you have suggested, ADHD often is overdiagnosed. All too often, the child simply is bored with their school curriculum, and huge behavioral changes can happen when a parent searches out an educational system that better fits their child’s needs. We must remember that education is not one-size-fits-all. Many children with ADHD are very sensitive to environmental influences, requiring a more “right brain” or creative educational environment, rather than the “left brain” environment of the public school system. Contrary to popular belief, even though these children often don’t do that well in school, they usually have above average intelligence.

It is common for ADHD children to have adverse reactions to certain foods, and while the foods will vary from child to child, the most common allergies are dairy, sugar, dye (especially red), preservatives, salicylates (found in many foods, including apples, dried fruits, cola drinks, as well as in additives like MSG and artificial colors) and sometimes soy products. This problem is often aggravated by the child being addicted to the very foods that cause changes in behavior.

When a child is having a reaction or expressing inappropriate behavior, it is sometimes hard to remember that underneath the “little monster” there is an intelligent child who needs to be treated with respect. It is important for children to understand the connection between consuming the wrong food and not feeling well. You can help by gently pointing out that the food they just ate probably is responsible for how they are feeling.

Food allergies can cause diverse and unexpected reactions. For example, I have seen athletic children lose all coordination after consuming red dye and/or sugar. It would greatly benefit your child to investigate possible food sensitivities.

Often, after being off a food group for two to four months, the child can consume it once to twice a week on “special occasions.” The good news is that the “allergic” reaction usually lasts only 12 to 20 hours. So that treat on Friday night or Saturday often will not be reactive when the child is back in school on Monday morning.

Besides the diet and school environment, there are a few supplements that can be very helpful. The most important ones I use are reishi (Ganoderma lucidum), omega-3 oils, theanine and phosphatidylserine (PS). In more than 70 percent of the cases I treat, I can get away with reishi alone. The dosage varies by age, weight, degree of problem and amount of “cheating” on the diet. Usually, a 5:1 or a 15:1 solid extract with 200 to 500 mg is consumed, starting with the higher dose and reducing it after three to four months. Reishi will calm the mind, reduce environmental and food sensitivities, and help the person have better focus.

For omega-3 supplements, I find that krill oil works the best (500 to 1,000 mg daily). It is three to six times more absorbable than fish oils, having a large percentage of the fatty acids in a phospholipid form. Other omega-3 oils also will work, although I have had negative effects with flaxseed oil.

Theanine is a unique free-form amino acid. It is a relaxant that increases alpha waves in the brain, producing mental and physical relaxation and decreasing stress and anxiety without inducing drowsiness. The dosage is 100 to 200 mg, twice daily.

In rare cases, I give the more expensive PS, although it is usually not required. The average dosage is about 100 mg twice daily.

Safe Weight Loss

I am trying to lose weight the safe way. I try not to use diet pills, because I don’t know which ones are safe. I also have high blood pressure and asthma. I need to lose about 20 pounds. I need help!
E.V.
Dalton, Pennsylvania

Khalsa responds: I’m glad you are concerned about safety, and are eschewing weight-loss drugs. If used appropriately, natural methods are quite safe.

Natural diuretics, such as uva ursi (Arctostaphylos uva-ursi), cause fast weight loss from water loss, but the effect is short term. Herbal laxatives eliminate a few pounds of weight from stool, and may reduce absorption. They work fast, but are a temporary fix. Both have side effects if used to excess. Neither targets fat.

Soluble fibers, such as psyllium (Plantago spp.), provide a feeling of fullness, and reduce fat absorption from the digestive tract. Start with a very small amount (a miniscule 1/4 teaspoon), and increase (by 1/4 teaspoon) with each meal. Drink a copious amount of water with the fiber.

To burn off accumulated fat calories, we can increase metabolic rate (daily calories burned), with a process called thermogenesis, which is popular these days, and effective. Helpful herbs in this category contain caffeine derivatives (chocolate-based products), ephedrine derivatives (ma huang), or yohimbine derivatives (yohimbe). All of these suppress appetite and increase metabolism. Plus, they are energizing, which helps with the fatigue from reduced food intake. But they are not suitable for someone with high blood pressure.

One standout weight-loss herb that is set to become popular is chá-de-bugre (Cordia ecalyculata), from Brazil. Widely promoted in Brazil as a weight-loss remedy, this herb is on its way to the United States. There is scarce science to back this up, though. Chá-de-bugre contains caffeine, so it is mildly energizing, decreases appetite and boosts urination. Little more is known about active constituents. Interestingly, it also heals cold sores and wounds, and reduces pain and swelling when applied topically.

Chá-de-bugre often is taken as tea. Rather than cutting off appetite, it creates a feeling of being full after a few bites. Drink it 30 minutes to one hour before a meal. Use 2 to 3 grams of powdered leaf in capsules one to three times daily, or the equivalent in tea.

Vegetarians weigh less than meat eaters, regardless of food intake or exercise, according to a recent published review. The scientists found that average body weight of vegetarians is 3 to 20 percent lower than that of meat eaters, without increased exercise or restrictions on portion sizes, calories or carbohydrates.

Said Susan Berkow, Ph.D., “Our research reveals that people can enjoy unlimited portions of high-fiber foods such as fruits, vegetables and whole grains to achieve or maintain a healthy body weight without feeling hungry.” According to the scientists, the mechanism may involve the way the body metabolizes plant foods. Apparently, a vegan diet causes an increased calorie burn after meals, so plant-based foods are used more efficiently as fuel, rather than being stored as fat. Insulin sensitivity is increased in vegetarians, easing nutrient absorption.

A vegan diet causes an increased calorie burn after meals.

Willard responds: Our modern diet and lifestyle make it virtually impossible for many individuals to maintain a normal, healthy body weight. Consequently, and unfortunately, weight control has become an obsession in our society. Other factors, such as nutritional deficiencies, metabolic abnormalities and, in some cases, glandular disturbances also might be present. These can contribute to weight management difficulties and must be remedied first before weight can be controlled effectively.

Often, adopting a healthy diet is all we really need to do in order to lose 20 pounds. This might mean keeping the calories low, but often it just means making better food choices — for example, avoiding fast foods, dairy, flour and sweets. It is useful to find out if you have Syndrome X (insulin resistance) or a candida problem. By adopting the programs for Syndrome X and/or candida, you often can lose weight while being able to eat as much approved food as you want. To determine if Syndrome X or candida is affecting you, try the free questionnaires on my clinic’s website, www.wrc.net.

The supplements that I use the most for weight loss are garcinia (Garcinia cambogia), conjugated linoleic acid (CLA) and digestive enzymes.

Garcinia grows along the west coast of India, where it has been used in food preparation for centuries. It supposedly makes a meal more filling. Studies on this plant go back to the late 1960s, but it was not until the 1970s that the pharmaceutical giant Hoffmann-La Roche started taking a serious look at its ability to stimulate weight loss. Over the next several years, garcinia was shown to decrease the production of cholesterol (especially bad cholesterol) and triglycerides, reduce appetite and increase energy while increasing thermogenesis. In 20 years of clinical use, it has been proven that garcinia continues to be effective even after extended use. It does not cause a rebound or the “yo-yo” effect associated with many weight-management plans. Long-term consumption is safe, even for diabetics, although the herb is not indicated during pregnancy, breastfeeding or for young children. It does not stimulate the central nervous system and does not cross the blood-brain barrier. It can combine nicely with other nutrients. I suggest 500 to 1,000 mg, 30 to 90 minutes before meals. This both lowers appetite and reduces fat production.

CLA from sunflower oil may prove to be the biggest breakthrough in weight management yet. Studies indicate that CLA can help decrease body fat while maintaining muscle. It also is useful in reducing sugar-related problems, such as hypoglycemia and type 2 diabetes (insulin resistance). Research shows that CLA increases the conversion of stored fat to usable energy and also inhibits the conversion of extra calories into stored fat. The dosage is 2 to 3 capsules, twice daily.

Digestive enzymes are important for weight management. By using a preparation of buffered hydrochloric acid and digestive enzymes, you ensure the proper breakdown of foods and absorption of vital nutrients. This can reduce the appetite, while preventing the growth of candida in the system. I suggest 1 to 3 capsules, depending on the size or density of the meal.

The best time of the year to try and lose weight is April to September. In the winter months, it is much more difficult. By adopting the above program, you should be able to lose 20 pounds and get back to a normal healthy weight, within four months.

Karta Purkh Singh Khalsa has more than 25 years of experience with medicinal herbs. A licensed dietitian/nutritionist, massage therapist and board member of the American Herbalists Guild, he specializes in Ayurvedic, Chinese and North American healing traditions.

Terry Willard is a clinical herbalist, president of the Canadian Association of Herbal Practitioners and founder of the Wild Rose College of Natural Healing in Calgary, Alberta, Canada. He is the author of eight books and a CD-ROM, Interactive Herbal.