Friday, January 28, 2011

My child was just diagnosed with ADD/ADHD… What should I do?

 There are a variety of treatment options for ADD/ADHD, including behavioral, educational and pharmaceutical. I’m going to limit my thoughts here to nutritional recommendations, as they are immediately under the control of most consumers. The other approaches have their place, and it’s important to have a team of professionals on board when dealing with this condition – don’t forget that it takes a village to raise a child.

The basis for health starts in the kitchen for many conditions, and ADD/ADHD is no exception. The most important changes to make for a child with ADD/ADHD are: less sugar, more protein, healthier fats, fewer additives, and more antioxidants. These are healthy recommendations for anyone, but have specific reasoning in this condition.

Less sugar and more protein are flip sides of the same coin. Unbalanced blood sugar is often a major contributor to a child’s inability to maintain focus in school. When blood sugar is very high, due to high sugar intake, energy levels are high, and the child may not be able to focus that energy productively. When blood sugar plummets as a reaction to high blood sugar levels, attention drops off. By keeping your child’s consumption of refined sugar to a minimum, you can prevent this spike and valley effect; this is especially important at breakfast, which sets the tone for the rest of the day. Protein is converted into sugars more slowly, thus maintaining a steadier blood sugar level throughout the day, and so it prevents the rise and fall. Most people think that protein comes in the form of meat only, but I often urge parents to consider eggs, nuts and seeds as good protein sources that can be consumed regularly.

A healthier fat profile is also important to successful management of ADD/ADHD. Unsaturated fats, such as those found in fish oil, have long been recommended to children with learning or behavioral challenges on the basis that they promote healthy growth of neural tissue. While I believe there may be some benefit to neural function, it’s not clearly been demonstrated. What is more likely, is that it may be due to the anti-inflammatory effect of unsaturated fats. The exact pathophysiology of ADD/ADHD is not yet understood, but little disease takes place in the body without inflammation, and so it is possible that this is the mode of action.

There has long been speculation that food additives may contribute to ADD/ADHD symptoms, but recent studies have begun to establish a stronger connection. The association is strongest with hyperactivity, and the link is becoming increasingly strong. Many of the studies indicate that increased consumption of food additives predisposes children to hyperactivity, but there are some studies showing that food additives may aggravate hyperactive behaviors in children already diagnosed with ADHD.

Finally, there has also been research indicating that antioxidants may be helpful in ADD/ADHD. Again, a clear mechanism has not been established, but it may be that the benefit provided by antioxidants is due to their anti-inflammatory effect.

If you were to take these recommendations and apply them to a diet, here’s what it would look like: minimal amounts of processed foods; little to no refined sugar; moderate amounts of fruit, grain and meat; copious amounts of vegetables; regular servings of nuts and seeds; regular servings of fish. This diet is fairly similar to what is now called the Mediterranean Diet, and while it requires a little work, it is one that provides benefit to the whole family, beyond the recently diagnosed child.

One lifestyle change that goes along with a diet like this is the need to cook regularly. While cooking does add a task to the day, it has two potential positive effects on a child with ADD/ADHD. One, it provides a potential outlet for the child; while not universally true, many children enjoy helping out with cooking, as it provides a lot of varied stimulus that will keep the child focused when they might normally be watching TV or tearing the house apart. Two, it has the potential of slowing down the pace of the household, generating a calmer atmosphere, which may rub off on your ADD/ADHD child.

ADD/ADHD is a tough diagnosis for a lot of families, because it’s a behavioral issue as well as a learning issue. It’s important to have a team of professionals with whom your can consult, from teachers, to learning aides, to coaches, to doctors, to counselors, etc. Finding the match that works best for you is key; follow your instincts, and make sure you feel that the people you work with are listening to you and are honestly engaged in helping your child achieve his or her potential. These dietary suggestions won’t fix everything (though you’d be surprised how far they can go!), but they will certainly give your child a solid base from which to work.

Monday, January 24, 2011

A brief note and an apology

So for the first time I missed the deadline I set for myself in getting a blog entry up each Friday. What can I say? It’s been a busy week and weekend!

I spent the weekend in Seattle learning and helping out with a class taught by Dr. Paul Herscu, a world-renowned homeopath. It was invigorating as ever, and we saw a number of fascinating cases, including the case of a young boy with dyslexia and behavioral issues. I always appreciate working with children, as they have a refreshing honesty that makes taking homeopathic cases easier than with many adults, and they respond very well to remedies – I personally think that this is because they are still growing, and have a remarkable ability to overcome illness and ‘redirect the course of their health’ so to speak. Adults are very much set in their ways and take much longer to heal than children, whose health can seemingly turn on a dime.

Coincidentally, I’ve been working on a longer post with dietary recommendations for ADD/ADHD. While far from comprehensive, it will feature recommendations that can be applied nearly universally. Keep an eye out for it on this Friday.

Saturday, January 15, 2011

How much Vitamin D should I take?

 I’m asked this question regularly, and my answer is very consistent: ‘It depends.’

I’ve brought this up today because new guidelines were recently set for Vitamin D’s Recommended Dietary Allowance (RDA). Previously, the guidelines were 200 IU per day for adults under 50, 400 IU per day for adults 50-70, and 600 IU for adults over 70. Most naturopathic physicians viewed these guidelines as woefully inadequate. The revised RDAs now recommend 600 IU per day for all people under 70, and 800 IU per day for adults over 70. These new guidelines are a step in the right direction, and are an indication that large organizations are paying attention to emerging data about Vitamin D. Most naturopaths would, however, still argue that these numbers are low, and that most people should take more.

Despite changes in the RDA, and despite calls to increase the number, I’m going to stick to my strict guideline of ‘It depends.’ The IOM’s decisions are based on a public health model, where they are trying to establish a baseline dose that will supply the majority of people with enough of a nutrient to ward off disease. To that end, they do not take into account the individual needs of a given person, but instead look for the peak of the bell curve, and how much that population needs. The needs of an individual person at a given time can and will vary.

As a consumer, though, how do you decide how much to take? The best way to determine this is to have a blood test done and to work with a doctor to bring your levels back into an optimal range. Many naturopaths will run this as a routine test along with cholesterol, blood sugar, iron, etc., because of increased knowledge of its importance in health. Most frequently, I have seen doctors initially recommend high doses of Vitamin D for a period of a few weeks or months in order to bring blood levels up to an optimal range, and then back off to a lower maintenance dose.

As we learn more about this as yet poorly understood nutrient, we will likely see greater and greater benefit, and RDAs will increase. At some point in the future, though perhaps not soon, we will also see a more individualized system of dosing develop. We’ll likely see recommendations altered for people living in more northerly climates, where the body’s own Vitamin D production drops in winter months. Additionally, we may see recommendations come out based on ethnic background and skin color, as people with darker skin may make less Vitamin D than lighter skinned people when exposed to the same amount of sunlight. Fortunately for all of us, Vitamin D continues to be one of the least expensive nutritional supplements around. For pennies a day, one can gain immense health benefit from this unique nutrient.

Friday, January 7, 2011

I’ve Heard Alternative Medicine is Dangerous…

 This is a topic that isn’t brought up in the US as often as it is in other countries, but it dovetails with the question of alternative medicine's efficacy. I’m bringing it up because I recently read an article stating that alterative treatments are dangerous and harmful. It’s a bit of a controversial topic, and one that engenders a lot of passionate arguments on both sides, but I want to write this article so it is helpful for consumers trying to make smart healthcare decisions.

I’m going to step briefly onto a soapbox for a moment and say that a double standard is held against naturopathic doctors in the arena of safety. In our media-driven age, isolated cases of adverse events are given disproportionate attention, and naturopathic doctors are called on to defend their system of medicine, whereas traditional medical doctors are not. That said, I want to underscore the fact that when dealing with sick people (as doctors do), the risk of adverse events or harm is always present, and it’s the skill of the practitioner that prevents them. Ok, off the soapbox now…

When I read reports like this, I fault the decisions made, not the tools used. In the article presented previously, there is a mention of a three-month old being put on a rice-milk diet for ‘congestion’ and dying five months later from septic shock and malnutrition. The tool, being a dairy-free diet, is indeed an appropriate treatment for some children suffering from allergies, frequent ear infections, asthma or eczema. However, the decision-making was poor, because infants, who have a need for the nutritional profile provided by breast milk, cannot subsist on rice milk alone. This was a tragic outcome caused by poor medical decision-making.

Another mention is made of a child who died of septic shock due to administration of homeopathic remedies and dietary restriction in an attempt to treat chronic eczema. As stated previously, a dairy-free diet or other dietary changes are indicated for eczema, and homeopathy may be used as an adjunct for this condition as well. However, the medical decision-making was likely at fault. While septic shock can arise very quickly, in most circumstances, there are several steps along the way. This is when medical decision-making kicks in. Appropriate monitoring and follow-up should have been able to prevent this.

As a consumer, these articles should not scare you away from natural treatments. Natural treatments generally have very few adverse effects, and are effective in a broad array of conditions. What this article should encourage you to do, however, is to seek out a properly trained practitioner from an accredited school. When seeking alternative care, do some research; ask them where they went to school, ask about their license, and about any additional training they may have had. Most naturopaths will be happy to talk with you about this, and many will be very excited to talk about their training! For further information, check out the AANP’s website, to learn more about accrediting, licensing, and to find a properly-trained naturopathic doctor in your area.

Sunday, January 2, 2011

What’s the Story with Food Allergies?

Like the debate over evidence-based medicine, this is an extensive, complicated debate that cannot be settled in one discussion – I’ll likely be returning to this many times in the future. According to the CDC, approximately 11 million Americans have food allergies, an increase of approximately 20% in the past decade. As a result, there has been considerable discussion over the cause of this increase, and how to test for allergies.

Most important for health care consumers to know is that the immune system is very complex, and that there are a number of ways that your body can react to foods, so there a number of ways to test. Some tests are very accurate and reliable, but others are less so, and are more open to interpretation.

The classic allergic reaction, which includes hives, difficulty breathing, and anaphylaxis, is caused by a rapid release of histamine. These allergic reactions happen very quickly, and are of the same type as hay fever or bee allergies. The most common foods causing this type of allergic reaction are peanuts, tree nuts, milk, eggs, soy and wheat. These types of allergies have clear, dramatic symptoms, and can be tested via blood tests. The results are usually definitive and reliable.

Less clear and less well-understood are what are technically termed food intolerances. The symptoms of these include headaches, joint pains, eczema, IBS, malaise and other symptoms. When dealing with these types of food reactions, lab tests are rarely as definitive. Occasionally, one or two foods will come up high on a fairly extensive list. Other times, a group of foods will come up high that can be clearly identified by a food type, e.g. legumes, nuts, wheat, or citrus fruits. In these cases, avoidance of the foods or food groups is appropriate, provided that avoidance results in symptom relief.

In a third, common situation, a large number of foods will come up as reactive without a clear pattern. In these situations, there are additional factors at play, including increased gut permeability (“leaky gut”) or increased immune activity due to other causes. Technology for diagnosing and understanding these types of food reactions is still developing, and the jury is very much out. When dealing with unclear testing results, I tend to encourage a regime of overall healthy eating, emphasizing whole foods. I usually avoid restrictive diets, as I have seen that the stress of avoidance and a restricted diet can be equally as challenging as the symptoms the patient is experiencing. I also often seek other medical causes or pursue other methods of treatment beyond food avoidance, such as constitutional homeopathy, supplements or herbal medicine.