ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
Attention Deficit Hyperactivity Disorder (ADHD) is a syndrome with many contributing causes, including toxic environmental impingements, nutrition deficiencies plus food and food additive sensitivities, and gut immunology mechanisms that directly affect the central nervous system. Throughout the United States, ADHD has become an alarming epidemic:
As pointed out in articles and writings by NOHA Professional Advisory Board Members J. Gordon Millichap, MD, and Theodore E. TePas, MD, certain important areas in the brains of patients with ADHD have been shown to be smaller and also have lower than normal metabolic rates. Again, this research was pointed out carefully in the opening lecture at the conference by the first speaker, Marianne M. Glanzman, MD. She also described the difficulty that individuals with ADHD have with focusing on important stimuli and filtering out the rest. They lack the mental ability to organize appropriate intentional behavior. Thus, we see why we have the seemingly contradictory situation where the symptoms of these overly active people can be helped sometimes by a drug that stimulates their brains.
Nicholas A. Ashford, PhD, JD, Professor of Technology and Policy, Massachusetts Institute of Technology, spoke about a new theory of disease that is developing: Toxicant Induced Loss of Tolerance (TILT), where a chemical exposure or a series of exposures can result in a loss of tolerance, often not just to one but to many different synthetic chemicals. Low-level exposures to chemicals, regulated by our government at "tolerance" levels (thought to be minimally harmful), have been found to be linked to "a host of new public health problems," which are increasing at a disturbing rate. Dr. Ashford gives many examples, including ADHD, depression, asthma, autoimmune diseases, and chemical sensitivity.
Classical disease explanations are no longer appropriate. There is no single agent disrupting one organ and resulting in one named "disease." Multi-stage processes are involved. Actually, the chemicals affect "communication systems or networks." The targets include the endocrine , the immune , and the neurological systems.
In his lecture Dr. Ashford highly recommended a new book, Chemical Brain Injury by Kaye H. Kilburn, MD. In NOHA NEWS, Fall 1993, Dr. Kilburn’s editorial, "Conserve Brains First, Else All May Be Lost," from the May/June Archives of Environmental Health was quoted:
Theo Colborn, PhD, of the World Wildlife Fund and lead author of Our Stolen Future: Are We Threatening Our Fertility, Intelligence, and Survival? told us about the acute sensitivity of the human fetus to chemical assaults at amazingly low levels. One hit, which does not affect the mother at all, can have devastating effects on the fetus lasting a lifetime.
We test for one chemical at a time. Testing is difficult and expensive. However, the manmade chemicals "are never found alone in living tissue. Conservatively speaking, everyone will have more than 500 measurable chemicals in his or her body."
Appropriate levels of the thyroid hormone are crucial for the developing fetal brain. Dr. Colborn told us about many ways in which manmade chemicals can affect thyroid function. We continue to have major environmental contamination. At present, "wildlife biologists cannot find a top predator fish in the Great Lakes that does not have enlarged thyroid glands." Persistent developmental delays have been found in children of mothers who ate Great Lakes fish (even as little as two or three meals per month.) "Normal thyroid hormones circulate at parts per billion and parts per trillion in pregnant women." Until birth the sole source of thyroid for the fetus is its mother. Although definite links have not been made between her child’s ADHD and combinations of synthetic chemicals that disrupt the pregnant mother’s thyroid, "it is not unreasonable to think that synthetic chemicals that can penetrate the body and are capable of interfering with the thyroid system would not have to be present in very high concentrations to change critical signals to the developing embryo."
Nutritional deficiencies in American children were vividly described by Donald R. Davis, PhD, a co-worker with NOHA Honorary Member, the late Roger J. Williams, PhD, whose book, Nutrition Against Disease, inspired the founding of NOHA in 1972. Dr. Davis spelled out the low levels in the American diet of many essential nutrients and pointed out, in addition, that we are just beginning to learn the benefits of hundreds of phytochemicals (from plant foods). He stated: "Do low nutrient levels, or low phytochemical levels, contribute to the problems of ADHD? I don’t know, but I think it is likely that they do." He pointed out that these low intakes of nutrients and phytochemicals "are caused primarily by heavy consumption of refined (non-whole, or ‘dismembered’) foods." Three kinds of non-whole foods: "refined sugars, added fats and oils, and white flour and rice . . . contribute well over 50% of the dry weight and calories of the American food supply."
Leo Galland, MD, pointed out specific nutrients that have been found low in children with ADHD, who then have been helped by appropriate changes in their diet and by supplements:
NOHA speaker Stephen Schoenthaler, PhD, summarized his extensive studies improving the diets of school children and also of incarcerated criminals. The children showed impressive gains in learning ability. In studies where the criminals were randomly assigned to a vitamin-mineral supplement group or to a control group, who received placebos, the subjects receiving the active pills became significantly less violent and also participated in significantly less antisocial behavior.
Food and Chemical Intolerances
William T. Kniker, MD, Clinical Professor of Pediatrics and Internal Medicine, University of Texas Health Center at San Antonio, lectured on adverse food reactions, especially those affecting the central nervous system (CNS). We experience both immediate and delayed reactions; the former are well studied; the latter not; and the latter are often involved in CNS reactions. Partially digested food particles (peptides) or additives can be absorbed through the gut wall, circulate in the blood, and trigger symptoms in any part of the body. Dr. Kniker listed many ways that foods can cause disease, including enzyme deficiencies, abnormal detoxification, opiate peptides from gluten (in grains, especially wheat) and casein (in milk), and individual hypersensitivities. His list of triggers included two familiar items: pesticides and stress.
Dr. Kniker has had a great deal of experience treating children with ADHD, who often had other syndromes like autism and symptoms like headaches and seizures as well. He emphasized important connections as follows:
The Nervous System [connected to BOTH:]
The Immune System
A few of the factors he listed, which may be associated with dysfunctions of the central nervous system, gut, and immune system include vaccinations, toxic effects of additives, vitamin and nutrient deficiencies, and toxic metabolites from gut microorganisms, as described by William Shaw, PhD. These metabolites are increased by excessive use of antibiotics. As we know, NOHA Honorary Member William Crook, MD, has been explaining for years how killing off the friendly bacteria with antibiotics results in upsetting the gut flora and a spiraling increase in problems.
Dr. Kniker told us about a number of dramatic cases. One ten-year-old boy with ADHD had erratic hyperactivity, sleeplessness, asthma (when he got red food dye), difficulty reading, throat clogging, and he was belligerent. Ritalin® was ineffective. "He craved sugar so much that he scooped up and ate handfuls from bowls whenever possible; he did the same with potato chips." He became "totally asymptomatic on a diet rotating safe food, symptoms return on dietary indiscretion."
Marvin Boris, MD, and Michael F. Jacobson, PhD, both listed careful scientific studies implicating food additives as triggers of ADHD in many children. With a colleague Dr. Boris has himself researched and published, "Food and additives are common causes of the Attention Deficit Hyperactive Disorder in children."
Gut Immunologic Mechanisms and CNS
Joseph A Bellanti, MD, and colleagues have found a pathologic overgrowth or inflammation (a lesion) of lymph tissue, which is part of the immune system, in the mucosal tissues of the ileum (a particular portion of the small intestine) in children with developmental diseases of the central nervous system, particularly ADHD and autism. This lesion is named Ileal Lymphoid Nodular Hyperplasia (ILNH) and they hypothesize that it is an actual tissue marker in the gastrointestinal tract for food allergy and many of the developmental delays in the central nervous system. Dr. Bellanti explained vividly the extreme importance of the gastrointestinal tract not only for digestion but also in our immune system; specifically it comprises "approximately 2/3 of the entire lymphoid system of the body." Also it has intimate connections with our nervous system. ("The gut is the largest reservoir of peripheral nerves in the body.")
Huge amounts of food are presented to the gut— "100 tons over a lifetime." Consequently, the gut immunologic system has to cope with a vast number of antigens. The mucosal barrier within the gastrointestinal system does not form until an infant is about 3 months old. This "gut closure" is facilitated by breast feeding. Breast milk not only contains secretary immunoglobulin A (which is essential for processing antigens) but also other immune cells, as well as certain growth factors that accelerate the maturing of the cells needed for our gut immune system.
Dr. Bellanti is the director of the International Center for Interdisciplinary Studies of Immunology at Georgetown University. He was our host at the conference and active in its implementation, especially along with Dr. Crook.
For many years NOHA Honorary Member William G. Crook, MD, has written and lectured about the major behavioral and other health problems, including ADHD, which are caused by yeast overgrowth in the gut. He has pointed out that yeast is no problem when in balance with beneficial bacteria in our gastrointestinal tracts. However, when antibiotics are used, overgrowth often occurs, and toxic metabolites develop and proliferate. See NOHA NEWS, XVI(2):4, XX(4):1-3, XXII(2):5,6.
Michael L. McCann, MD, lectured on the "leaky gut syndrome" and its connections to food allergies, eczema, and behavioral disorders, including ADHD. Dr. McCann has found the use of pancreatic enzymes and probiotics most helpful, in addition to and sometimes instead of avoidance of food triggers. Like many other speakers at the conference, he pointed out the major problems in our whole bodies when partially digested proteins escape from the gut. Pancreatic enzymes can be swallowed, when they have a coating that will protect them from breakdown by stomach acid, and then these enzymes will assist in the further digestion of protein peptides.
Especially interesting was Dr. McCann’s work with probiotics—the live, friendly bacteria of which Dr. Crook has so often spoken. Dr. McCann found probiotics surprisingly helpful in his practice. Then, he discovered the work of European researchers who have studied and compared the bowel flora of newborn infants, born in sterile, Western environments, with the flora of those born "in less sterile, more natural conditions in ‘underdeveloped’ countries." The babies born in the poor countries had healthy flora whereas those born in the rich countries, especially when the mothers received antibiotics, had less beneficial bacteria and more toxin-producing microorganisms. When the development of the children from the rich countries was followed, they were found to be many times more allergic ("atopic") than those who had been born with healthy bowel flora in the poor countries.
Summing up his presentation, there is evidence that children with ADHD are atopic and have increased bowel permeability (Dr. Bellanti’s ILNH). Dr. McCann pointed out that some drugs, such as aspirin, increase bowel permeability. Whatever the cause of the leaky gut, many neurotoxins can then escape and cause symptoms.
On the last day of the conference two scientists from the National Institutes of Health spoke about government programs. Dr. Heather Ringeisen from the National Institute of Mental Health said it would be excellent to have government studies of some of the factors affecting ADHD, which the speakers had presented. However, she admitted that the panel of doctors, who decide on research grants, have been giving them for studies of drugs that control symptoms, rather than for research on the fundamental causes of ADHD, which have been addressed at this conference.
Hopefully, like the way interest in new treatments for autism has exploded, this excellent conference will be just a beginning and will generate more and larger conferences. Strong interest has been generated across disciplines, in academia, and among clinicians. Certainly, this conference will spur many more research studies on combinations of factors that can cause ADHD. This article barely touches on the many presentations.
Finally, in view of the dangerously increasing incidence of ADHD and our knowledge of the exquisite sensitivity of the brain to chemical insults, we need to heed the policy recommendations of Professor Ashford and advocate "The Precautionary Principle" on all levels from the individual to the international and including doctors advising each patient on reducing dangerous exposures, hopefully before the conception of the especially vulnerable fetus.
*On November 4-7 your editor attended a conference on "Attention Deficit Hyperactivity Disorder: Causes and Possible Solutions," sponsored by The Georgetown University Medical Center Office of Continuing Professional Education and co-sponsored by The International Center for Interdisciplinary Studies of Immunology, Georgetown University Medical Center, and the International Health Foundation, Jackson, Tennessee. This article is a brief summary of the many fascinating presentations.
Article from NOHA NEWS, Vol. XXV, No. 1, Winter 2000, pages 1-3.