-IBIS-1.7.6-
tx
mental/emotional
Attention-Deficit Hyperactivity Disorder/ADD
Nutrition
dietary guidelines
therapeutic foods:
whole-foods diet, high in protein and complex carbohydrates; reduce sugar and simple carbohydrates.
(Zametkin, Nordahl, et al, 1990; Langseth, Dowd, 1978.)
increase foods that calm the Shen (Spirit), tonify the Heart, harmonize the Stomach and Spleen
increase foods rich in Vitamin B-complex
longan, oyster, rice, rosemary, wheat, wheat germ, mushroom
Chinese:
» Heart Xue Xu (Blood Deficiency), Spleen Qi Xu (Deficiency), and also in Yin Xu (Deficiency), Yang hyperactivity:
nourishing, cooked, warm, clear bland diet, with slightly increased animal protein to help manufacture sufficient blood, for example, soups with black beans, chicken or beef broth, and plentiful root and leafy green vegetables (Flaws, 1997, p. 262)
specific remedies:
2 oz. fresh walnuts, 2 oz black sesame seeds, crush together and eat three times daily (Butt and Bloomfield, 149.)
for nervous tension: 3 oz. fresh oysters, 3 oz. peanuts, 2 oz. celery. Boil in 2 pt water until reduced to half. Divide into 2 halves and eat and drink twice daily for 7-14 days (Butt and Bloomfield, 149.)
if indications of lead toxicity, via hair analysis, use foods that will chelate: pectin (apples), alginate (seaweed) methionine, cysteine and cystine-foods such as beans, eggs, onions, and garlic (Marz, 314-315.)
avoid:
avoid food additive sensitivities - eliminate processed foods that contain artificial colors, flavors, sweeteners, and preservatives, commonly listed as benzoates, nitrates, and sulfites; common food additives also include calcium silicate, BHT, BHA, benzoyl peroxide, emulsifiers, thickeners, stabilizers, vegetable gums, and food starch. (McGovern, 1983; Egger J, et al. Lancet. 1985 Mar 9;1(8428):540-545; Egger, et al, 1992; Rowe KS, Rowe KJ. J Pediatr. 1994 Nov;125(5 Pt 1):691-698.)
"Feingold hypothesis"- Benjamin Feingold, M.D. estimated that 40-50% of hyperactive children are sensitive to artificial food colors, flavors, and preservatives as well as naturally occurring salicylates and phenolic compounds. His claims were based on over 1,200 cases in which food additives were linked to learning and behavior disorders. (Feingold)
avoid salicylate-containing foods:
- Fruits-almonds, apples, apricots, cherries, currants, nectarines, peaches, plums and prunes
- Berries-blackberries, boysenberries, gooseberries, raspberries, strawberries
- Grapes and raisins or any product made with grapes - wine, wine vinegar, jellies, foods containing fruit juice sweeteners
- Oranges (note: grapefruit, lemon and lime are permitted)
- also, many spices: cardamom, cinnamon, cloves, curry, oregano, paprika, pepper, rosemary, sage, turmeric (Swain, Soutter, et al., 1985.)
In a study of hyperkinetic children and behavioral changes associated with diet, acetyl salicylate was the phenolic compound provoking the greatest frequency of responses (80%), while from foods, sugar, corn, beef and egg were the next most common offenders at 30%. (McGovern, 1983.)
avoid additives and phenolics:
The Hyperactive Children's Support Group of Great Britain recommends avoiding the following:
Tartrazine, Sunset Yellow, Benzoic acid, amaranth, Red 2G, Brilliant Blue FCF, Carmine, Quinoline Yellow, FCF, Carmoiic acid, Sulfur dioxide, Potassium nitrate, BHT, Caramel, Cochineal, Sodium benzoate, Sodium nitrate, BHA, Indigo, (Swanson, Kinsbourne, 1980; Brown, 276.)
minimize food sensitivities: eliminate or reduce the intake of cow's milk, soy, eggs, wheat, citrus, and other potential allergenic foods (McGovern, 1983; Egger, et al, 1992.)
minimize sugars and simple carbohydrates to reduce risk of hypoglycemic reactions:
75% of criminals were hyperactive children and more than 50% have abnormal GTT's. Hypoglycemia can stimulate increased catecholamine secretion.
(Langseth, Dowd, 1978.)
avoid meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods, coffee, caffeine, sweet foods and sugar
» Chinese:
Phlegm Obstructing the Heart Orifices:
avoid Sweet, Cold and Damp foods which either weaken the Spleen, such as chilled, cold, raw foods or sugar and sweets, or foods which cause Dampness and Phlegm, such as sugar and sweets, dairy foods, and fatty, greasy, fried foods (Flaws, 1997, 262.)
Heat Shi (Excess): eliminate all food additives, colorings and flavorings; avoid oranges, sugar and red meat, as well as Hot foods such as hot spices, shellfish and curries (Scott)
Heat and Phlegm Shi (Excess): eliminate Phlegm-producing foods such as dairy and peanut butter; high freequency of gluten intolerance which causes green phlegm and nasal congestion; avoid Sweet and Damp foods (Scott)
Middle Jiao Xu (Deficiency), including Spleen Qi Xu (Deficiency): limit sweets and fruit juices, especially restrict cold food and drinks; no ice (Scott)
Kidney Qi Xu (Deficiency): limit sweets and cold food; no ice (Scott)
supplements
Vitamin B-complex: very important for hyperactive children; helps to relax a stressed nervous system and improve mental functioning and concentration; give the dose, preferably in a liquid format, recommended on the product label for two months, then decrease the dosage to five days a week for three months; thereafter, stop giving the supplement altogether. ((Brenner,1982; Zand J, et al, 267.)
Vitamin B3 1 g per day; Niacinamide 1-3 gms per day (Hoffer, 1971.)
Vitamin B6 50 - 100 mg per day (Bhagavan, et al, 1975.); 20 - 30 mg/kg/day, esp. if patients have low serum serotonin levels, this treatment may be beneficial. (Coleman, 1979.)
Vitamin B12 IM injection 1-3 cc/every week
Vitamin C: 1,000 mg twice daily for adults; 500 mg twice daily for children; can be especially beneficial if indications of lead toxicity, via hair analysis, then 3 g per day for chelation effect (Marz, 314-315.)
Vitamin E 400 IU per day
Liquid calcium and magnesium supplement for its calming effect on the nervous system; children from five to seven years old should take 1 teaspoon, once daily; children seven to ten years old should take 1 teaspoon, twice daily; children ten years and older should take 1 tablespoon, once or twice daily. Follow this regimen for two months, then decrease the dose to five days a week for three months. Then stop giving the supplement altogether. (Zand J, et al, 267.)
Chromium: 200 micrograms daily (Mertz, 1969.)
Copper: 0.5 to 1 milligram daily
Magnesium 500 mg per day, especially consider this if the patient is constipated
Zinc 5 to 10 milligrams daily (Ward, et al, 1990.)
DHA (Docosahexaenoic Acid): a polyunsaturated omega-3 fatty acid, an essential building block of brain tissue that is crucial for communication between neurons; plays a vital role in brain development of infants and children; can improve concentration.
(Horrobin; Mitchell EA, et al. Clin Pediatr 1987 Aug;26(8):406-411; Stordy BJ. Lancet 1995 Aug 5;346(8971):385.)
Essential Fatty Acids: 2 - 4 teaspoon/day; note: males have a much higher requirement for EFA than females; check for other allergies such as asthma and eczema. Colquhoun and Bunday published research findings in which five hyperactive children received 1-1.5 gms evening primrose oil twice a day with very positive results.
(Stevens LJ, et al. Am J Clin Nutr. 1995 Oct;62(4):761-768; Colquhoun I, Bunday S. Med Hypotheses. 1981 May;7(5):673-679.)
Choline appears to improve memory and attention span in some children; try giving 500 milligrams a day for one month with a child fourteen years of age or older (Zand J, et al, 267.)
Lecithin (Bastyr)
Proanthocyanadins
footnotes
Brenner A. Food additives and behavior. Md Med J. 1986 May;35(5):344-345.
Brenner A. The effects of megadoses of selected B complex vitamins on children with hyperkinesis: controlled studies with long-term follow-up. J Learn Disabil. 1982 May;15(5):258-264.
Brenner A. Trace mineral levels in hyperactive children responding to the Feingold diet. J Pediatr. 1979 Jun;94(6):944-945.
Brown D. Herbal Prescriptions for Better Health. Prima Publishing, Rocklin, CA, 1996.
Coleman M, Steinberg G, Tippett J, Bhagavan HN, Coursin DB, Gross M, Lewis C, DeVeau L. A preliminary study of the effect of pyridoxine administration in a subgroup of hyperkinetic children: a double-blind crossover comparison with methylphenidate. Biol Psychiatry. 1979 Oct;14(5):741-751.
Abstract: A small sample of six patients with the putative "hyperkinetic syndrome" participated in a research protocol comparing administration of pyridoxine, methylphenidate, and placeboes. The children had had low whole blood serotonin levels and a history of previous responsiveness to methylphenidate. The results of the double-blind clinical evaluation showed trends suggesting that both pyridoxine and methylphenidate were more effective than placebo in suppressing the symptoms of hyperkinesis. Pyridoxine elevated whole-blood serotonin levels, methylphenidate did not. Clinical and laboratory evidence indicated that the pyridoxine effects persisted after the 3-week period when the vitamin had been given in this experimental design.
Collins-Williams C. Intolerance to additives. Ann Allergy. 1983 Aug;51(2 Pt 2):315-316.
Colquhoun I, Bunday S. A lack of essential fatty acids as a possible cause of hyperactivity in children. Med Hypotheses. 1981 May;7(5):673-679.
Abstract: 5 hyperactive children received EPO 1-1.5 gms 2x/day with very positive results.
The Hyperactive Children's Support Group (HCSG) in an organisation with over 70 branches in Britain devoted to helping such children and their families. We have carried out a detailed survey of the characteristics of many of our children and their families and have studied the literature in detail. We have come to the conclusion that many of these children have a deficiency of essential fatty acids (EFAs) either because they cannot metabolise linoleic acid normally, or because they cannot absorb EFAs normally from the gut, or because their EFA requirements are higher than normal. The main pieces of evidence are: 1. Most of the food constituents which cause trouble in these children are weak inhibitors of the conversion of EFAs to prostaglandins (PGs). 2. Boys are much more commonly effected than girls and males are known to have much higher requirements for EFAs than females. 3. A high proportion of our children have abnormal thirst and thirst is one of the cardinal signs of EFA deficiency. 4. Many of our children have eczema, allergies and asthma which some reports suggest can be alleviated by EFAs. 5. Many of our children are deficient in zinc which is required for conversion of EFAs to PGs. 6. Some of of our children are badly affected by wheat and milk which are known to give rise to exorphins in the gut which can block conversion of EFAs to PGE1. A preliminary study of EFA supplementation in a number of our children has given promising results. We hope that others with better facilities will be encouraged to test out this hypothesis.
Egger J, Stolla A, McEwen LM. Controlled trial of hyposensitisation in children with food-induced hyperkinetic syndrome. Lancet. 1992 May 9;339(8802):1150-1153.
Egger J, Carter CM, Graham PJ, Gumley D, Soothill JF. Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome. Lancet. 1985 Mar 9;1(8428):540-545.
Abstract: 76 selected overactive children were treated with an oligoantigenic diet, 62 improved, and a normal range of behaviour was achieved in 21 of these. Other symptoms, such as headaches, abdominal pain, and fits, also often improved. 28 of the children who improved completed a double-blind, crossover, placebo-controlled trial in which foods thought to provoke symptoms were reintroduced. Symptoms returned or were exacerbated much more often when patients were on active material than on placebo. 48 foods were incriminated. Artificial colorants and preservatives were the commonest provoking substances, but no child was sensitive to these alone.
Egger J, Carter CH, Soothill JF, Wilson J. Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior. Clin Pediatr (Phila). 1992 May;31(5):302-7.
Feingold B. Why Your Child Is Hyperactive. Random House, 1975.
Flaws B. A Handbook of TCM Pediatrics: A Practitioners Guide to the Care and Treatment of Common Childhood Diseases. Blue Poppy Press, Boulder, CO, 1997.
Hoffer A. Hyperactivity, allergy and megavitamins. Can Med Assoc J. 1974 Nov 2;111(9):905, 907. (Letter)
Hoffer A. Treatment of hyperkinetic children with nicotinamide and pyridoxine. Can Med Assoc J. 1972 Jul 22;107(2):111-112.
Hoffer A. Vitamin B3 dependent child. Schizophrenia. 1971;3:107-113.
Abstract: 33 children under age 13 with disturbed behavior were placed on nicotinamide with doses from 1.5 to 6 gms daily along with 3 gms ascorbic acid, rarely tranquilizers or antidepressants also. All recovered and then had their nicotinamide tablets switched to placebo tablets. Only 1 out of 33 children failed to respond to B3 therapy. All of the children that responded to the B3 relapsed upon substitution with placebo, then improved again upon restarting the B3.
Langseth L, Dowd J. Glucose tolerance and hyperkinesis. Food Cosmet Toxicol. 1978 Apr;16(2):129-133.
Abstract: 261 hyperactive children were given 5-hour GTT's; 74% of these children had abnormal curves. The predominant curve was a flat one.
Levy F, Dumbrell S, Hobbes G, Ryan M, Wilton N, Woodhill JM. Hyperkinesis and diet: a double-blind crossover trial with a tartrazine challenge. Med J Aust. 1978 Jan 28;1(2):61-64.
Abstract: A pilot study was conducted on 22 children (19 boys and three girls) aged between four and eight years, who were selected as hyperactive on the basis of developmental history and clinical judgement. Conners' parent-teacher ratings, objective tests of attention, standard perceptualmotor tests and subtests from the Wechsler Intelligence Scale for Children (WISC), were used as response variables. The children were tested before and after four weeks on the elimination diet, after a tartrazine and placebo challenge, and, finally, after a four-week washout period on the diet. Results showed a statistically significant improvement in the mothers' ratings of the children's behaviour after the first four weeks of the diet. The improvement was maintained in a combined analysis of the initial four-week diet period and four-week washout period. This result was not substantiated by the statistical analysis of the results from objective tests. The rating scales and objective tests for the full sample did not show a statistically significant deterioration in the children's behaviour when they were challenged under double-blind test conditions with the Yellow Dye No. 5, tartrazine, and the tests were conducted the day after a two-week challenge period. A comparison of mother ratings of behaviour during challenge and placebo double-blind trial and in the 24 hours preceding tests, in a subgroup of the children who, while on the diet, showed a 25% reduction of symptoms on the Conner's rating scale, indicated a significant challenge effect (P less than 0.025), with mothers reporting more symptoms during the challenge period. Dietary infringements with suspected trigger substances occurred throughout the trial.
Marz R. Medical Nutrition From Marz. Second Edition. Omni-Press, Portland, OR; 1997.
McGovern. Int J Biosocial Res. 1983;4:40-42.
Mitchell EA, Aman MG, Turbott SH, Manku M. Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clin Pediatr (Phila) 1987 Aug;26(8):406-411.
Abstract: This study compared 48 hyperactive children with 49 age-and-sex-matched controls. Significantly more hyperactive children had auditory, visual, language, reading, and learning difficulties, and the birth weight of hyperactive children was significantly lower than that of controls. In addition, significantly more hyperactive children had frequent coughs and colds, polydypsia, polyuria, and a serious illness or accident in the past year than controls, but there was no increase in asthma, eczema, or other allergies. Serum essential fatty acid (EFA) levels were measured in 44 hyperactive subjects and 45 controls. The levels of docasahexaenoic, dihomogammalinolenic, and arachidonic acids were significantly lower in hyperactive children than controls.
Rowe KS, Rowe KJ. Synthetic food coloring and behavior: a dose response effect in a double-blind, placebo-controlled, repeated-measures study. J Pediatr. 1994 Nov;125(5 Pt 1):691-698.
Abstract: OBJECTIVE: To establish whether there is an association between the ingestion of synthetic food colorings and behavioral change in children referred for assessment of "hyperactivity." PARTICIPANTS: From approximately 800 children referred to the Royal Children's Hospital (Melbourne) for assessment of suspected hyperactivity, 200 were included in a 6-week open trial of a diet free of synthetic food coloring. The parents of 150 children reported behavioral improvement with the diet, and deterioration on the introduction of foods noted to contain synthetic coloring. A 30-item behavioral rating inventory was devised from an examination of the clinical histories of 50 suspected reactors. Thirty-four other children (23 suspected reactors, 11 uncertain reactors) and 20 control subjects, aged 2 to 14 years, were studied. DESIGN: A 21-day, double-blind, placebo-controlled, repeated-measures study used each child as his or her own control. Placebo, or one of six dose levels of tartrazine (1, 2, 5, 10, 20, 50 mg), was administered randomly each morning, and behavioral ratings were recorded by parents at the end of each 24 hours. RESULTS: The study identified 24 children as clear reactors (19 of 23 "suspected reactors," 3 of 11 "uncertain reactors," and 2 of 20 "control subjects"). They were irritable and restless and had sleep disturbance. Significant reactions were observed at all six dose levels. A dose response effect was obtained. With a dose increase greater than 10 mg, the duration of effect was prolonged. CONCLUSION: Behavioral changes in irritability, restlessness, and sleep disturbance are associated with the ingestion of tartrazine in some children. A dose response effect was observed.
Schulte-Korne G, Deimel W, Gutenbrunner C, Hennighausen K, Blank R, Rieger C, Remschmidt H. [Effect of an oligo-antigen diet on the behavior of hyperkinetic children]. Z Kinder Jugendpsychiatr Psychother. 1996 Sep;24(3):176-183. [Article in German]
Abstract: The influence of an oligoantigenic diet on different dimensions of the behavior of 21 children diagnosed as having attention-deficit hyperactivity disorder (ADHD) was examined. Treatment effects were assessed with three subjective measures (two questionnaires and an interview) and three objective measures (two attention tests and actometer). The study was divided into three phases: baseline, diet and provocation, each lasting three weeks. A crossover design was used. A significant effect was found for the subjective measures, but not for the objective measures. The results are discussed in terms of possible types of effects, e. g. rater effects and environmental effects. It may be that the oligoantigenic diet influences only certain dimensions of hyperactivity.
Scott, Julian. The Acupuncture Treatment of Hyperactivity and Attention Deficit Disorder. Northwest Regional Acupuncture Conference, November 1996.
Stevens LJ, Zentall SS, Deck JL, Abate ML, Watkins BA, Lipp SR, Burgess JR. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr. 1995 Oct;62(4):761-768.
Abstract: Study found that 53 subjects with ADHD had significantly lower concentrations of key fatty acids in the plasma polar lipids and in red blood cell total lipids than did the 43 control subjects. Also, a subgroup of 21 subjects with ADHD exhibiting many symptoms of essential fatty acid (EFA) deficiency had significantly lower plasma concentrations than did 32 subjects with ADHD with few EFA-deficiency symptoms.
Stordy BJ. Benefit of docosahexaenoic acid supplements to dark adaptation in dyslexics. Lancet 1995 Aug 5;346(8971):385. (Letter)
Swain. Salicylates, oligoantigenic diets, and behavior. Lancet, July 6, 1985, 41-42. (Letter)
Swanson JM, Kinsbourne M. Food dyes impair performance of hyperactive children on a laboratory learning test. Science. 1980 Mar 28;207(4438):1485-1487.
Abstract: Forty children were given a diet free of artificial food dyes and other additives for 5 days. Twenty of the children had been classified as hyperactive by scores on the Conners Rating Scale and were reported to have favorable responses to stimulant medication. A diagnosis of hyperactivity had been rejected in the other 20 children. Oral challenges with large doses (100 or 150 milligrams) of a blend of FD & C approved food dyes or placebo were administered on days 4 and 5 of the experiment. The performance of the hyperactive children on paired-associate learning tests on the day they received the dye blend was impaired relative to their performance after they received the placebo, but the performance of the nonhyperactive group was not affected by the challenge with the food dye blend.
Ward NI, Soulsbury KA, et al. The influence of the chemical additive tartrazine on the zinc status of hyperactive children - a double-blind placebo-controlled study. J Nutr Med. 1990;1:51-57.
Weintraub, Skye. Natural Treatments for ADD and Hyperactivity. Woodland Publishing, Pleasant Grove, UT, 1997.
Zametkin AJ, Nordahl TE, et al. Cerebral glucose metabolism in adults with hyperactivity of childhood onset. New Engl J Med. 1990;323:1361-1366.
Zand J, Walton R, Rountree B. Smart Medicine for a Healthier Child. Avery Publishing Group, Garden City Park, NY, 1994.