RUNNING HEAD: ADHD CAM Modalities

1

ConditionMonograph for NAT 504

CAM Modalities & ADHD

Management

By Kimmer Collison-Ris, MSN, FNP-C, WOCN

ADHD and CAM Modalities

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ADHD Management via Complimentary Medicine

Name of Condition

Attention Deficit Hyperactivity Disorder (ADHD) is a neurological condition characterized

by the inability to concentrate in a sustained manner, pay attention to tasks, and to control

impulsive actions (Sorgi, Hallowell, Hutchins, and Sears 2007). The exact etiology is unknown

but major multifactorial contributors include brain inflammation (Sears, 2011) adverse food

additive responses, food intolerances, sensitivities to environmental chemicals, molds, and fungi,

and exposures to neurodevelopmental toxins (ie. heavy metals and organohalide pollutants).

Thyroid hypofunction may also be a link with toxic insults in ADHD symptomatologies (Kidd,

2000). The Huffington Post (March 26, 2013) cited a study published in The Journal of

Neurology demonstrating “an association between having higher infection levels in the blood

and risk of cognitive problems." Genetics is also suspected to play a role.

Persons with ADHD struggle with development in emotional, educational, and social deficits;

the impact of poor therapy has a negative effect on their future possibilities. Many individuals do

not respond to conventional stimulant therapy alone, however, reported nutritional intervention

appears to compliment conventional therapy, possibly playing a greater role in the etiology of

ADHD syndrome (Starobrat-Hermelin and Kozielec 1997).

Body System Affected

Brain and Nervous System

Pathophysiology

Scientific theorists, believe ADHD is related to abnormalities in the frontostriatal brain

circuitry and possible hypofunctioning of dopaminergic pathways; this is consistent with the

benefits obtained in some cases with the use of psychostimulants (Kidd, 2000). Among the

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genetic and environmental influences is an observed decrease in long-chain (LC)

polyunsaturated fatty acids (PUFAs) in children with ADHD. Proposed mechanisms for the low

levels of PUFAs include insufficient dietary intake, inefficient conversion of shorter chain

PUFAs to LC PUFAs or rapid metabolism of LC PUFAs (Sorgi, Hallowell, Hutchins, and Sears,

2007). Other recent evidence also suggests a deficit in cortical inhibition via the GABA-ergic

system (γ-aminobutyric acid) report researchers Edden, Crocetti , Zhu, Gilbert, and Mostofsky

(2012). As previously mentioned, The Journal of Neurology found a link between brain

inflammation and infection and cognitive problems.

Allopathic Diagnosis and Treatment

Diagnosis is based upon a medical history, physical exam, and a comparison of the Connor’s

Parent Teacher rating scales showing behavioral disruption in two different environments over a

period of time . Laboratory data would show no evidence of other medical conditions.

Allopathic providers believe the primary factor in ADHD development is related to the status of

the monoamine system which impacts serotonin, dopamine, norepinephrine, and epinephrine.

Pharmaceutical treatment is aimed to impact the monoamine systems with neutral sulfate salts

like dextro-amphetamine and amphetamine, methylphenidate, dexmethylphenidate, atomextine,

and lisdexamfetamine dimesylate. However, they are unable to increase the total number of

neurotransmitter molecules in the central nervous system (Hinz, Stein, Neff, Weinberg, and

Uncini, 2011).

When to Refer

Clinical Diagnosis of ADHD requires a licensed medical provider, psychologist, psychiatrist,

or PhD educational specialist. If the client is suspected of having ADHD but has not been

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formally diagnosed, a CAM provider must refer to one of the above providers for testing and

analysis because other conditions like nutritional deficiencies, inflammation, or

allergy/sensitivities can mimic attentional and behavioral problems.

Integrative Perspective of Causes

The dietary intake pattern of general populations in Asian and American countries often

reflects many nutrient deficiencies, especially essential vitamins, minerals, and omega-3 fatty

acids. Rao, Asha, Ramesh, and Rao (2008) report, that “few people are aware of the connection

between nutrition and depression while they easily understand the connection between

nutritional deficiencies and physical illness. A notable feature of the diets of patients suffering

from mental disorders is the severity of deficiency in these nutrients”.

The Western diet is inflammatory. In sensitive individuals, an inflammatory diet may cause

symptoms of inattention, hyperactivity, aggression, irritability, and mood swings (Bube, 2013;

Sears 2011; Feingold n.d.). Research is also suggestive of toxic buildup in sensitive individual’s

systems which can contribute to the symptoms of ADHD. The Western diet is unable to

eliminate environmental or food contaminants and likely intensifies these symptoms. Murray and

Pizzorno (2010) hypothesize that dietary alterations may serve as a useful tool to detoxify

individuals unable to eliminate toxic buildup.

Specialized Integrative Analysis

Increasing evidence demonstrates that many adolescents with behavioral problems are

sensitive to >1 food components that negatively impact their behavior. Schnoll, Burshteyn, and

Cea-Aravena (2003) found that individual response was an important factor for determining the

proper approach to treating children with ADHD. Artificial food colors (AFCs) have not been

established as the main cause of ADHD, but accumulated evidence suggests that a subgroup

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shows significant symptom improvement when consuming an AFC-free diet and reacts with

ADHD-type symptoms on challenge with AFCs. Of children with suspected sensitivities, 65% to

89% reacted when challenged with at least 100 mg of AFC. Oligoantigenic diet studies

suggested that some children in addition to being sensitive to AFCs are also sensitive to common

nonsalicylate foods (milk, chocolate, soy, eggs, wheat, corn, legumes) as well as salicylate-

containing grapes, tomatoes, and orange (Stevens, Kuczek, Burgess, Hurt, Arnold 2011;

Feingold n.d.; Murray and Pizzorno 2010).

Reactive hypoglycemia is a commonly undiagnosed problem that manifests as symptoms of

ADHD, treatment includes eating protein and a complex carbohydrate about every two hours to

avoid the spikes and extreme drops in blood sugars which cause irritability, agitation,

restlessness, hyperactivity, poor concentration, and fatigue. Dr. Barry Sears (2011) reports

inflammation of the brain cells results in increased neurological disorders, including ADHD.

Integrative Support Protocols

Integrative ADHD support protocols are designed to help maintain focus and concentration;

as well as channel frustrations, anxiety, and energy. Whole foods diet is a key CAM Therapy in

the management of ADHD and is comprised of an organic nutrient dense whole foods diet that

omits food aggravators. Because nutrient deficiencies are common in ADHD; supplementation

with minerals, the B vitamins, omega-3 and omega-6 essential fatty acids, flavonoids, and the

essential phospholipid phosphatidylserine can ameliorate ADHD symptoms. Nutritional factors

such as food additives, refined sugars, food sensitivities/allergies, and fatty acid deficiencies

have all been linked to ADHD. There is increasing evidence that many children with behavioral

problems are sensitive to one or more food components that can negatively impact their behavior

(Schnoll, Burshteyn, and Cea-Aravena, 2000). When individually managed with

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supplementation, dietary modification, detoxification, correction of intestinal dysbiosis, and

other features of a holistic program of management, the ADHD subject can lead a normal and

productive life (Kidd, 2000).

Dietary Support

The following steps have been useful in decreasing ADHD symptoms in the table below.

Step Rationale

1. Treat reactive hypoglycemia. Hypoglycemia can mimic ADHD

2. Consume an anti-inflammatory whole foods diet. Inflammation has been implicated in ADHD

3. Eliminate all caffeine, sodas, prepared/prepackaged

foods, candy, and cookies .

Food colors, preservatives, flavorings, and additives can

cause behavioral issues in sensitive individuals.

4. Eat whole low-processed foods like eggs, meats,

cheeses, fresh vegetables and fruits, nuts, seeds, and

legumes.

A whole /low processed foods diet is anti-inflammatory and

decreases food sensitive triggers.

5. Avoid all white flour, refined sugars, high fructose

corn syrup, artificial colors & additives .

These foods are implicated in contributory to symptoms of

ADHD.

6. Consume a low gluten, low casein diet. These foods have been helpful in some individuals sensitive

to casein & gluten.

7. Make whole foods appealing by choosing color,

variety, and textures.

A varied diet may help avoid food triggers and cravings &

is higher in anti-oxidants.

8. Drink large amounts of fresh filtered water, to help

brain and body cells function properly and flush out

body toxins.

Chemical water additives have been implicated in

environmental causes of ADHD; fresh water flushes out

toxins.

9. Keep weight healthy and monitor it regularly. Obesity and ADHD are directly linked.

10. Ingest appropriate levels of high dose

micronutrients.

Micronutrients help to correct nutritional imbalances, boost

the immune system, & help detoxify the body.

11. Get 60 minutes of physical activity/exercise daily. Physical activity increases circulation; helping to detoxify

the body, & channels excess energy.

Food Supplement Therapy (Vitamins & Minerals)

CAM providers have found food supplements help decrease ADHD symptoms (see table 2).

Name Rationale Caution

Vitamin C Antioxidant, anti-inflammatory,

improved the behavior in persons w/ ADHD

L-carnitine formed from an amino acid and helps cells in the

body produce energy

- A study found that 54% of a group of boys with

ADHD showed behavioral improvement

-no studies exist on safe use in children

-may also worsen hypothyroid symptoms,

interact with some medications, and lower

seizure threshold persons with previous

seizure history

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Vitamin B6 Adequate levels of vitamin B6 are needed for the

body to make and use brain chemicals, including

serotonin, dopamine, and norepinephrine

- B6 pyridoxine was slightly more effective than

Ritalin in improving behavior among hyperactive

children.

High doses of Vitamin B6 can be dangerous

and cause nerve damage

GABA Is a neurotransmitter in the brain and is the main

inhibitory neurotransmitter, resulting in

calming effects.

Essential

fatty acids

from fish oil

(omega-3

fatty acids)

play a key role in normal brain function

- Studies reveal that children with ADHD who take

the oil supplements for a period of three months,

show significant improvements in spelling, reading,

and behavior.

-use with caution as high doses may increase

the risk of bleeding

Iron - ADHD kids tend to have low ferritin levels ( iron

storage protein)

-Low iron alters dopamine activity & slows brain

development

Iron levels must be analyzed before

instituting treatment.

Magnesium Symptoms of magnesium deficiency include

irritability, decreased attention span, and mental

confusion

- A study of 75 magnesium-deficient children with

ADHD, those who received magnesium supplements

showed an improvement in behavior compared to

those who did not receive the supplements

Caution should be exercised as magnesium

can interfere with certain medications,

including antibiotics and blood pressure

medications and be dangerous.

Zinc regulates the activity of brain chemicals, fatty acids,

& melatonin which are related to behavior; helps

regulate the function of the neurotransmitter

dopamine; Research shows that zinc significantly

reduces hyperactivity and impulsivity; Low zinc is related to weakened intestinal integrity

Adult women who are pregnant or

breastfeeding should limit their intake of zinc

to 40 mg per day to avoid pregnancy or

infant development complications.

Botanical Therapy

Herbs help to strengthen and tone the body's systems; several botanical formulations for

ADHD management are sold in the United States and Europe, but few scientific studies

have investigated whether these herbs improve symptoms of ADHD. Herbs are formulated as

dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol

extracts). One or more of the following botanicals may be recommended for reducing ADHD

symptoms people (see table 3 below):

Name Rationale Caution

Bacopa (Bacopa monnie

ri)

aka brahmi

sedative and improves anxiety &hyperacti

vity;

improves memory and concentration

Can cause temporary hearing loss in

women, interacts w/estrogen therapy

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Roman chamomile

(Chamaemelum nobile).

Calming;

relieves allergies, inflammation, & insom

nia

-may cause an allergic reaction in people

sensitive to Ragweed;

-may have estrogen-like effects

--use with caution in hormone-related

conditions, (ie. breast, uterine, or ovarian

cancers, or endometriosis).

-can interact with some medications

Evening Primrose

Oenothera biennis

(contains Omega 3 Fatty

Acids, Linoleic Acid,

Gamma Linoleic Acid &

omega-6 fatty acids)

lack of various polyunsaturated fatty

acids can contribute to attention deficit

hyperactivity

Lowers seizure threshold in persons

taking anti-epileptics, schizophrenic meds

Ginkgo Biloba(Gingko

biloba)

-used to improve memory & mental

sharpness; improves inattention &

immaturity problems; increases blood

flow to the brain; helps w/ADHD sx that

affect intellectual functions

- used with caution in diabetes, seizures,

infertility, & bleeding disorders

-can interact with meds (esp. blood-

thinning agents)

Ginseng (American or

Siberian)

American ginseng

(Panax quinquefolium)

- known for memory boosting benefits

- increases brain levels of

neurotransmitters dopamine and

norepinephrine

-- Imbalances lead to disruption in

attention span, motor behavioral

dysfunctions, and auditory processing

delays.

- One study found gingko along

w/ginseng improved ADHD sx

American ginseng caution in diabetes,

hormone-sensitive conditions, insomnia,

or schizophrenia

-can interact (esp blood-thinning agents)

Gotu Kola (Centella

asiatica)

improves memory, concentration

& mental fatigue

breast feeding women and pregnant

women must avoid the use

Grapeseed Extract protects from excitotoxins

Hawthorn Relieves acting out & stops inflammation

caused by allergies

Interacts w/cardiac meds, not indicated

for use in children, pregnancy, or

lactation

Lemon balm

(Melissa officinalis)

gentle, safe calming herb for anxiety

& depression; relaxes

nervous system, eases agitation.

avoided by individuals affected by

glaucoma

Passionflower

(Passiflora incarnata)

calming sedative that causes less drowsin

ess than drugs

-may interact with sedative medications.

Scullcap Indicated for aggressive & agitated

persons; helps decrease

anxiety, restlessness, crying spells, irritabi

lity, &nervousness.

Useful daytime sedative that works

w/o drowsiness;

prevents allergic reactions.

-may decrease leukocyte count

-use under supervision as can damage the

liver

St. John’s Wort

(Hypericum perforatum)

nervine tonic, antidepressant,

regulates mood and attention;

inhibiting the

reuptake of serotonin, inhibits the reupta

ke of norepinephrine and dopamine w/eq

ual affinity;

has an affinity for GABA receptors

Interacts w/other meds, esp anti-

depressants

Valerian (Valerian increase in concentration and abilities and -can interact with some meds

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officinalis) energy levels -can induce drowsiness

-can interact with sedative meds

Digestion/Apsorption of Nutrients

Maximum absorption of key nutrients is essential for overall body health and nervous system

function. Digestive enzymes can increase nutrients and supplement absorption; many persons

note improvement in ADHD symptoms when taking broad-spectrum enzyme or those targeting

specific compounds.

Digestive Enzymes Rationale

Amylase breaks down carbohydrates, starches, &sugars

Cellulase breaks down cellulose, plant fiber

Protease breaks down proteins (found in meats, eggs, cheese, and nuts

Lipase breaks down fats (found in most dairy products, meats, oils, and nuts)

Papaya digestive

enzymes

Important for food/nutrient breakdown & assimilation

Homeopathy

Homeopathic remedies address each person's constitutional type -- physical, emotional, and

psychological makeup; an experienced homeopath assesses these factors when determining the

most appropriate individual’s treatment. One study of 43 ADHD diagnosed children, showed

significant improvement in behavior when they received an individualized homeopathic remedy

compared to children who received a placebo. Homeopathic remedies found to be most effective

included: Stramonium, for children who are fearful, especially at night; Cina -- for children who

are irritable and dislike being touched; whose behavior is physical and aggressive ; and

Hyoscyamus niger -- for children who have poor impulse control, talk excessively, or act overly

exuberant (Wisegeek, 2013).

Sleep Hygiene

Persons with ADHD often have disordered sleep patterns that contribute to behavior and

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attention issues. Stimulant medications prescribed for ADHD often disrupts sleeping patterns

causing insomnia. Melatonin helps to promote sleep in persons with ADHD and may improve

behavioral and attention (Wisegeek, 2013).. Experts suggest melatonin is effective when taken

for 3 weeks on and one week off (Sears, 2011).

Adjunctive CAM techniques

Yoga, meditation, and self-calming activities, along with increased physical activity (walking,

weight lifting, swimming and biking have been useful in persons with attentional issues.

Massage

Relaxation techniques and massage can reduce anxiety and activity levels in children

adolescents, and adults with ADHD. In one study, teenage boys with ADHD who received 15

minutes of massage for 10 consecutive school days showed significant improvement in behavior

and concentration compared to those who were guided in progressive muscle relaxation for the

same duration of time (WiseGeek, 2013).

Biofeedback

Mind/body techniques such as hypnotherapy, progressive relaxation, and biofeedback may be

useful in treating individuals with ADHD. Through these techniques, individuals are often able

to learn coping skills they can use for the rest of their lives. These treatments allow persons to

gain a sense of control and mastery, increase self esteem, and decrease stress. Biofeedback

operates on the principle that individuals can be trained to modify brain activity associated with

ADHD and increase brain activity associated with attention. Several studies have shown positive

results (Burton, 2008).

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Summary

Further research is needed in the area of CAM ADHD botanical and food supplement therapy

and management; as well as the dietary and environmental influences that cause inflammation in

ADHD. Children, Adolescents, and adults respond differently to ADHD treatments and need a

variety of modalities available to address their unique needs beyond Allopathic prescription

medications.

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