ADD
Natural Support
By
James South, M.A.
Editors note: The following article contains some material which expands upon information presented in Dr. Ward Dean's ADD article in the last issue of Nutritional News. I recommend that Dr. Dean's article be read first. Related ADD articles in this issue include Eating Right for Peak Energy & Weight Management, Magnesium--The Underappreciated Mineral of Life and Optimal Brain Function and Proanthocyanidins which can all be found on this website.
In order to understand the central importance of Dr. Dean's recommendation of high protein, high fat, low carbohydrate meals for ADD children (and adults, too!), it is first necessary to understand some basic facts of life about human brain chemistry and function. The importance of a high protein/low carbohydrate diet in an ADD child stems from several factors. Dr. Dean noted that children are normally very metabolically active and are efficient glucose (sugar) burners.(1) Consequently, they need to maintain a constant, high-normal blood sugar level. However, a high sugar/processed carbohydrate meal lowers brain-essential blood sugar levels. How does this happen? Although the brain weighs 2% of total body weight, it produces and uses 20% of the body's total ATP bioenergy production. Unlike most other body cells, which are quite content to use fat as their fuel to burn to make ATP energy, the brain can use only glucose (sugar) to produce its massive ATP energy needs.(2) Under normal conditions, the brain uses 50% of all the circulating blood sugar to provide for its energy needs, including the energy needed to sustain focused attention! The brain, unlike other body cells (liver, muscles, heart, fat cells, etc.), does not need insulin to remove glucose from the blood.(2)
Unfortunately, a high sugar/processed carbohydrate meal causes the release of large quantities of the hormone insulin. When blood insulin levels are high, all the body's trillions of cells pull glucose from the blood, dramatically and rapidly lowering blood sugar levels, thus depriving the brain of its needed fuel.(2) A hypoglycemic brain may not have enough energy (since it can't store even a minute's worth of sugar fuel) to maintain extended, focused, laser-like attention.
The only way the brain can grab its disproportionately large share of blood sugar is for blood insulin levels to remain low. A meal with high protein (combined with low carbohydrates) releases the hormone glucagon, insulin's opposite.(2) Glucagon raises blood sugar--just what the active body and brain of a child requires. A healthy child's liver can store enough glucose (in the form of glycogen, a storage starch) to maintain proper blood sugar levels for 8-12 hours, without any food being eaten. It is glucagon which releases this liver glycogen to raise blood sugar as needed.(2) Dr. Dean inferred--but did not specifically state--that high protein must be combined with low carbohydrates. This distinction is important to emphasize, because if a large amount of sugar/processed-carbohydrate food is eaten along with large doses of protein, the insulin release may be doubled compared to the same amount of carbohydrate eaten without protein,(2) provoking a hypoglycemia roller-coaster effect. In addition, the glucagon which would be released by the high protein intake would be completely inhibited by the insulin surge. It is when blood insulin is low that the other body cells will ignore blood sugar and burn fat to provide the energy they need, thus leaving blood sugar for the brain's use.(2) Therefore, it should be noted that it is only through minimizing blood insulin levels that the brain can receive the essential blood sugar (fuel) it needs to function properly--i.e., glucose.
The importance of adequate fat along with the high protein, low sugar/low carbohydrate meal stems from the fact that a moderate to large quantity of fat in a meal along with fiber significantly slows gastric (stomach) emptying time.(3) The meal is digested over several hours, slowly trickling sugar into the bloodstream, and thereby avoiding insulin-induced hypoglycemia. In contrast, the typical high-sugar/processed carbohydrate, low-protein, low-fat, low-fiber meal favored by so many children, especially for breakfast (sugar-loaded cereals, pancakes, toast, etc.) may be digested and absorbed within 20-45 minutes, bringing about a rapid blood sugar rise followed by an insulin-induced blood sugar crash.
Dr. Dean's recommendation of DMAE (dimethylaminoethanol) for ADD children is based not just on years of clinical experience, but upon basic brain physiology. DMAE is part of the choline cycle, which allows cells to convert certain specific biochemicals into each other as needed. One of the key roles for choline is as the rate-limiting factor in the production of acetylcholine. Acetylcholine is one of the dozen or so major neurotransmitters which allow brain and nerve cells to communicate with each other.(3) Acetylcholine-using neurons are especially important in: 1) cognitive (intellectual) function; 2) memory formation and emotional modulation; and 3) the reticular-activating system (RAS). The RAS is a group of nerve clusters which sits at the top of the spinal cord and acts as a traffic controller. The RAS determines what stimuli from the senses will be allowed to reach conscious attention, as well as what thoughts and feelings will be allowed to initiate corresponding bodily movements. It is partly due to the RAS that a passing angry thought or feeling doesn't automatically and instantaneously trigger violent behavior toward the object of our anger. Within the RAS, it is the acetylcholine-using gigantocellular nucleus which is the principal consciousness-activator portion of the RAS.(2) This RAS activation effect is directly relevant to ADD. It is the intensity of signals (mediated by DMAE-derived acetylcholine) from the RAS to the hippocampus and cerebral cortex which determines the intensity and duration of sustained mental focus and attention--the very issue at the root of genuine attention deficit disorder. Thus DMAE, by being the most effective precursor for brain/RAS acetylcholine, literally increases attention span, mental focus, and ability to screen out distracting and extraneous stimuli (both from the environment as well as from within).
DMAE is the most effective acetylcholine precursor for several reasons. Choline salts (e.g. choline bitartrate, choline chloride, choline citrate) are frequently broken down by bacteria living in our gut.4 DMAE does not suffer this fate. What choline is absorbed into the bloodstream has a poor ability to cross the blood-brain barrier.(5) The blood-brain barrier is a two-part barrier which prevents toxins from entering the brain and also prevents disruptions of brain function due to surges in the blood of various nutrients, even those essential for optimum brain function.
Unlike choline, DMAE passes easily through the blood-brain barrier. Because of this fact, DMAE has been shown to be effective at doses as low as 10-20 mg, although doses of 500-1,000 mg are often needed. The unique effectiveness of DMAE is also due in part to its ability to inhibit choline oxidase, an enzyme which can divert choline away from acetylcholine production, into betaine production instead. And while a third acetylcholine precursor, phosphatidylcholine, is more effective than simple choline salts, studies have found large (and expensive) doses--10 to 60 grams(!) --are often needed to elevate brain acetylcholine levels.(5)
Another feature of the RAS may also serve to explain the connection of hyperactivity to the ADD phenomenon. About 25-40% of ADD children also suffer from hyperactivity. As already noted, the RAS is the general activator of the brain--sort of like a dimmer-switch which can turn the intensity of focused consciousness and mental attention from low to medium to high. As Dr. Arthur Guyton notes: An especially large number of nerve fibers pass from the motor regions [brain centers that control bodily movement] of the cerebral cortex to the reticular formation; therefore motor activity [behavior and movement] is associated with a high degree of reticular activation, which partially explains the importance of moving around when one wishes to remain awake.(2)
An acetylcholine-deficient RAS will have a difficult time maintaining a high level of focus, attention, alertness and arousal. Combine this with a class environment that is (as Dr. Dean notes) to many children boring and unchallenging, and consequently, there is no stimulus to activate the RAS to in-turn activate the brain/mind to alertness and attention. These children may then be left with no (instinctive, unconscious) option other than movement--i.e., fidgeting, jumping out of seats, throwing paper air planes, etc.-- in a last-ditch attempt to maintain alertness in such a mind-numbing, anti-alertness/attention environment. And this is why DMAE, which increases acetylcholine production, is useful both for increasing attention span and reducing hyperactivity.
Although DMAE is naturally found in the human body and brain, and is very non-toxic, it still must be used with care. Precisely because DMAE is such an excellent acetylcholine-booster, it may in some people produce a syndrome of acetylcholine-excess. Acetylcholine is not only an important brain neurotransmitter, it is also the neurotransmitter used by the nerves that control muscles to contract muscles. Symptoms of DMAE/acetylcholine excess include: 1) headache; 2) tense muscles - especially jaw, neck and shoulder; 3) irritability and/or depression; 4) restlessness; and 5) insomnia. These are not toxicity symptoms; they are signs of too much acetylcholine in the brain and muscles. Simply stopping DMAE for a day or two and restarting at a lower dosage will normally eliminate these symptoms if they occur. It is best to start off with low doses of DMAE (10 to 100 mg) and wait a week before increasing the dose. There is a cumulative dose-effect that occurs in the first few days of use, so that a dose that seems innocuous on day one may, by day three or four, elicit the acetylcholine-excess syndrome. Supplemental magnesium, at a dose of 2-3 mg per pound of body weight, may serve to rapidly eliminate any symptoms of acetylcholine excess.
Magnesium is capable of improving ADHD (ADD with hyperactivity), often all by itself. This is not surprising given magnesium's influences on so many physiological processes. In fact, a large portion of classic magnesium deficiency symptoms are identical to many of the problems displayed by children (and adults!) suffering from ADD: irritability, motor (muscular) restlessness, difficulty with mental concentration and memory, confusion and disorientation, apathy, emotional lability, and learning disability! (For more on this subject, see the articles Magnesium: The Underappreciated Mineral of Life Parts I and II on this website). Interestingly, the number one drug used to treat ADD, RitalinTM, is known to increase blood adrenaline levels which produce urinary magnesium losses significant enough to seriously sensitize the organism to further stressors.
In order to maximize dietary magnesium absorption and minimize magnesium urinary losses, individuals would have to give up sugar, chocolate, soft drinks, loud music, hamburgers, hot dogs, cheese, pizza, milk (shakes), ice cream, and salty foods -- all of which is unlikely. It is equally unlikely that many ADD kids will become non-junk food vegetarians with a diet high in fresh, uncooked vegetables grown on heavily magnesium-fertilized soils. Thus, the simple and effective way to remedy magnesium deficiency is through magnesium supplements. In the case of ADHD children taking Ritalin, magnesium supplements may actually minimize the side effects and maximize its benefits.
An optimum magnesium intake--especially under stressful life conditions--is approximately 2.7 - 4.5 mg magnesium per pound of body weight. Ideally, magnesium intake should be divided into two or three doses, with meals.
Proanthocyanidins, the active ingredients in grape seed extract, probably help ADD brains gradually (over weeks to months) recover to the higher brain energy level needed to sustain mental focus and concentration. Proanthocyanidins are powerful protectors of blood-brain barrier integrity.
When the blood-brain barrier integrity is damaged, this allows toxins and excesses of certain nutrients to leak into brain cells, with results ranging from mild disruption of function (as in ADD) to neuronal death.
Proanthocyanidins are extremely safe.
Although 30 - 50 mg doses of grape seed extract proanthocyanidins are generally taken, 100 mg is a more truly therapeutic dosage.
For more information on causes and natural treatments of ADD beyond the scope of this brief article, the reader is referred to the following books:
- Natural Treatments for ADD and Hyperactivity (6)
- Control Hyperactivity ADD. Naturally (7)
- No More Ritalin - Treating ADHD without Drugs (8)
Regarding the role of vaccinations (especially those received before age five) in the cause of minimal brain dysfunction (the old name for ADD) and hyperactivity, the reader is referred to:
Vaccination, Social Violence, and Criminality: The Medical Assault on the American Brain.(9)
This 1990 book is the most well-researched, documented, comprehensive, integrated and damning overview of the role of vaccinations in promoting brain dysfunction ever written. Every parent who loves their children should read it. JS
References:
1. Dilman, V. and Dean W. The Neuroendocrine Theory of Aging Pensacola, Florida: The Center for Bio-Gerontology. 1992.
2. Guyton, A. Textbook of Medical Physiology Philadelphia: W.B. Saunders. 1986.
3. Pike, R. and Brown, M. Nutrition, An Integrated Approach NYC: Macmillan. 1984.
4. Canty, D. et al. Lecithin and Choline Ft. Wayne: Central Soya Co. 1996.
5. Lewis, A. DMAE: An Overview of Its Health Effects and Potential Uses Florida, NY: Far East Trade Co. 1990.
6. Weintraub, S. Natural Treatments for ADD and Hyperactivity Pleasant Grove, Utah: Woodland. 1997.
7. Sahley, B. Control Hyperactivity A.D.D. Naturally San Antonio: Pain and Stress Pub. 1996.
8. Block, M. No More Ritalin - Treating ADHD without Drugs NYC: Kensington. 1996.
9. Coulter, H. Vaccination, Social Violence and Criminality - The Medical Assault on the American Brain Berkeley: North Atlantic Books. 1990.
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