How Nutrition, proper specific Hydration, Inflammation and Body Flora effect ADHD (attention –deficit hyperactivity disorder)

DSM-5 Criteria for ADHD

People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development: (1)

 

    1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
  • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
  • Often has trouble holding attention on tasks or play activities.
  • Often does not seem to listen when spoken to directly.
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
  • Often has trouble organizing tasks and activities.
  • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
  • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
  • Is often easily distracted
  • Is often forgetful in daily activities.

 

    1. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
  • Often fidgets with or taps hands or feet, or squirms in seat.
  • Often leaves seat in situations when remaining seated is expected.
  • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
  • Often unable to play or take part in leisure activities quietly.
  • Is often “on the go” acting as if “driven by a motor”.
  • Often talks excessively.
  • Often blurts out an answer before a question has been completed.
  • Often has trouble waiting his/her turn.
  • Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

  • Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
  • Several symptoms are present in two or more setting, (such as at home, school or work; with friends or relatives; in other activities).
  • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
  • The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

 

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

 

Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months

 

Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months

 

Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention was present for the past six months.

Because symptoms can change over time, the presentation may change over time as well.

Changes in the DSM-5

The fifth edition of the DSM was released in May 2013 and replaces the previous version, the text revision of the fourth edition (DSM-IV-TR). There were some changes in the DSM-5 for the diagnosis of ADHD:

  • Symptoms can now occur by age 12 rather than by age 6;
  • Several symptoms now need to be present in more than one setting rather than just some impairment in more than one setting;
  • New descriptions were added to show what symptoms might look like at older ages; and
  • For adults and adolescents age 17 or older, only 5 symptoms are needed instead of the 6 needed for younger children.

Experts agree that some adults do not grow out of ADHD and may have difficulty with time management, organizational skills, goal setting, and employment in their grown-up lives. some individuals do show enough improvement after puberty that they no longer need medication. But the American Academy of Family Physicians reports that two-thirds of children with ADHD continue to grapple with the condition throughout adulthood. These adults may also have problems with relationships, self-esteem, and addictions. Implementing a specific ADHD focused nutrition plan early on will help manage and reduce symptoms.

Let’s examine the causes of ADHD. Although the exact cause of ADHD is unknown, ongoing brain research has led scientists to the following factors:

  • Genetic: The fact that ADHD tends to run in families suggests that it can be inherited. (2)
  • Chemical imbalance: Some research has shown that an imbalance of neurotransmitters may contribute to ADHD. (1)
  • Brain changes: Areas of the brain that control attention are thought to be less active with those who have ADHD. (3)
  • Head Injury: Research has shown those who have suffered a brain injury or concussion have symptoms that mimic ADHD. (4)
  • Excessive playing of video games (not causing ADHD but increasing symptoms) (5)
  • Inflammation: Inappropriate inflammation over a long period of time can lead to the damage or destruction of tissue that can ultimately lead to several chronic disorders including ADHD. (6)

Inflammation

Is inflammation a silent killer? Perhaps. However, it is worth asking when in human history and where around the world inflammation has become implicated in the pathophysiology of chronic degenerative diseases. A comparative human biological approach reveals substantial variation in the level and dynamics of inflammation within and across populations, and it points to ecological factors during development as key contributors to this variation. It also reminds us that inflammation plays a central role in innate defenses against infectious disease, even as current research tends to focus on chronic inflammation and diseases of aging. Hopefully, consideration of the eco-logics of inflammation will point to promising directions for future research that advances our understanding of this important physiological system and translates into novel approaches to the prevention and treatment of disease.

Inflammation effects ADHD in many ways, one of them being the insulin mechanism. Excess inflammation can cause carbohydrate and sugar cravings leading to poor insulin regulation, stimulating the opiate receptors in the brain, triggering addictive behaviors along with detrimental health consequences.

THE METABOLIC SYNDROME AND INFLAMMATION In a 5-year prospective study published in the Journal of the American Medical Association, Yaffe and colleagues looked at the association of the metabolic syndrome and inflammation with cognitive decline in 2632 subjects with a mean age of 74 years.2 Cognitive impairment was more likely to develop in subjects who had the metabolic syndrome (n = 1016) than it was in those who did not (26% vs 21%), but those with concurrent high levels of inflammation were at significantly higher risk (adjusted relative risk, 1.66) for cognitive impairment. The study tracked all-cause cognitive impairment, which included both vascular dementia and AD. “The metabolic syndrome could be causing the inflammation, or inflammation could lead to metabolic dysregulation,” Yaffe said. “It’s probably bidirectional, but I think that inflammation as measured in serum reflects something in the brain that may be independent of the metabolic syndrome. There is an interesting interaction with cardiovascular disease, metabolic syndrome, and inflammation; if you have both [of the latter], you do worse.” Yaffe is preparing a manuscript that describes the results of another study showing that the metabolic syndrome is a risk factor for mild cognitive impairment and all-cause dementia in a separate patient population. “One take-home message is that these things-obesity, insulin resistance, diabetes, metabolic disturbances, and dysregulation-are clearly bad for the brain as well as the body. (12)

Proper Hydration through Hydroxide Rich Water for Treating ADHD and Inflammation

Acidity and inflammation go hand in hand. By chemical definition, acidity is a problem of too much hydrogen (H+). Too much acidity in the body can stem from diet, disease, exercise, and other life style factors. It is generally recognized that excess acidity in the body creates inflammation which leads to other disease conditions. Acidity causes a lack of oxygen and a lower pH condition in which pathogens flourish.

Hydroxide (OH) is a natural hydrogen hunter that does not merely buffer the body against excess hydrogen but eliminates it by combining with it to form harmless water. That water can then be used for hydration or eliminated through urination. Here is the formula of the elimination reaction: OH + H+ = H2O.

Most alkaline waters attempt to help the body buffer acidity by providing alkaline minerals. But this does not address the underlying problem of excess hydrogen and instead only helps the body maintain pH balance. Potential hydrogen (pH) balance helps the body but it does not fix the issue. The main goal of most alkaline waters is pH balance but this misses the point.

A water rich in hydroxide seeks to eliminate acidity by eliminating the excess hydrogen. Most alkaline waters contain some hydroxide if they claim either to contain negative ions or have gone through ionization. The problem is most alkaline waters rely more on alkaline minerals to buffer the excess hydrogen than they use the hydroxide to eliminate hydrogen. This is why it is imperative to find a hydroxide rich water because elimination is far more effective in restoring balance to the body than mere buffering.

Benefits of a hydroxide rich water:

  • Hydroxide eliminates acidity rather than just buffering the acidity.
  • Hydroxide produces no toxic by-products. It produces only water which can be used for hydration or eliminated through urination.
  • By eliminating excess acidity (hydrogen), it frees up the body’s own oxygen to use for other biological processes.
  • Hydroxide restores completely the acid-alkaline balance beyond just pH balance.
  • Hydroxide helps reduce inflammation by eliminating acidity and not just buffering it.

 

Brain / Gut Connection

The human body is an incredibly complex system, and since time immemorial man has struggled to work out what exactly his gut and his brain have to do with his health, and whether perhaps the two are connected somehow. We now know that the gut and the brain are both actually part of a marvelously intricate immune defense system, each doing its part to protect the body from sinister pathogenic invaders. Thus we have the intestinal barrier and the blood-brain barrier (BBB), two immune barrier systems that have the same purpose: to prevent invasion, infection and disease. This singularity of defensive purpose is reflected in the similarities between the gut and brain immune systems that extend to the actual structures, mechanisms and even biochemistries of the two systems. In fact, the two systems go beyond similarity, and actually communicate with and influence each other. Bidirectional signaling between the brain and gut has been confirmed by numerous studies. This communication between the gut and brain is ongoing from birth, and plays a significant role in shaping how the brain is wired. The gut’s influence on the brain cannot be overestimated, so much so that it can be called a second brain. Studies have linked gastrointestinal diseases to autoimmune diseases and brain-linked disorders such as type 1 diabetes, depression, anxiety, multiple sclerosis and autism. There is an awareness now that neurodegenerative diseases may not exclusively have a neurological trigger. Uncontrolled chronic inflammation, disturbances in the gut microbiota and other gastrointestinal-related dysfunctions have been linked to neurodegenerative and autoimmune disorders and the failure first of intestinal and then blood-brain barrier function. This opens the possibility of prevention, amelioration and even reversal of autoimmune disorders through treatment modalities involving the repair of the intestinal barrier and the BBB, thus restoring the functionality of many organs. (7)

Research, stemming from collaborative efforts of experts across medical sciences, is providing important, clinically relevant information about the progression of diseases that cross body barriers. The mysteries of multi-faceted neuro-immune disorders, such as Autism Spectrum Disorders, autoimmune thyroid disorders and chronic fatigue syndrome, ADHD, are being solved through pioneering medical scientists. Although the combined disciplines are relatively new, there are scores of important publications. Based on the prevalence of gluten sensitivities and depression, several studies illustrate gut-to-brain connections, through mapping the biomolecular cascades beginning with stressors, which inflame the gut, and ending in neuronal death. People exhibiting clinical complaints ranging from gastrointestinal upset to migraine or from depression to fatigue should be assessed for increased intestinal permeability by measuring antibodies against tight junction proteins and antibodies against lipopolysaccharides (8)

The brain-gut axis is a bidirectional communication system between the central nervous system and the gastrointestinal tract. Serotonin functions as a key neurotransmitter at both terminals of this network. Accumulating evidence points to a critical role for the gut microbiome in regulating normal functioning of this axis. In particular, it is becoming clear that the microbial influence on tryptophan metabolism and the serotonergic system may be an important node in such regulation. There is also substantial overlap between behaviors influenced by the gut microbiota and those which rely on intact serotonergic neurotransmission. The developing serotonergic system may be vulnerable to differential microbial colonization patterns prior to the emergence of a stable adult-like gut microbiota. At the other extreme of life, the decreased diversity and stability of the gut microbiota may dictate serotonin-related health problems in the elderly. The mechanisms underpinning this crosstalk require further elaboration but may be related to the ability of the gut microbiota to control host tryptophan metabolism along the kynurenine pathway, thereby simultaneously reducing the fraction available for serotonin synthesis and increasing the production of neuroactive metabolites. The enzymes of this pathway are immune and stress-responsive, both systems which buttress the brain-gut axis. In addition, there are neural processes in the gastrointestinal tract which can be influenced by local alterations in serotonin concentrations with subsequent relay of signals along the scaffolding of the brain-gut axis to influence CNS neurotransmission. Therapeutic targeting of the gut microbiota might be a viable treatment strategy for serotonin-related brain-gut axis disorders.(9)

This plan will help reduce inflammation.

It is rich in Omega 3 fatty acids

Low in processed sugar

Optimal high quality proteins,

Dye free and chemical free PURE whole foods are recommended as much as possible.

This plan incorporates:

Healthy Fats

Antioxidants

Fiber

Optimal macro nutrients

This plan will help optimize gut flora balance, and brain function.

Specific water and foods that can help fight inflammation include:

Hydroxide rich water *specific details to follow in this segment

Heart healthy nuts

Nut butters and seeds like walnuts

Pumpkins seeds,

Heart healthy oils like coconut oil, extra virgin olive oil,

Antioxidant rich produce, including berries and dark leafy greens.

Consider gastrointestinal health.

Working with your doctor, you may want to add probiotics to your supplement regimen, along with the supplement tricycline (which contains berberine, artemisinin, citrus extract, and walnut hulls).

This treatment is designed to improve problems related to leaky gut, a condition in which damaged intestinal walls release undigested food particles into the bloodstream. Leaky gut is associated with a range of inflammatory and immune responses including ADHD. (9)

This nutrition plan will work best in additional to a support team; it is ideal for those who are under supervised clinical treatment and therapies of qualified health professionals.

Lifestyle/Environmental Impact

Certain lifestyle trends and habits may contribute to the increase or decline of ADHD symptoms. Poor nutrition, infections, and substance abuse (including cigarette and alcohol use) during pregnancy may be contributing factors. Substance abuse during pregnancy is believed to affect the development of the fetus’s brain as well.

Exposure to toxins, such as lead, in early childhood can also affect brain development. Excessive video game playing or television watching does not cause ADHD, but can accentuate its symptoms. (6) Likewise, eating too much sugar does not cause ADHD, however, can accelerate symptoms.

But, a balanced diet, rich in nutrients, is essential for babies and children to develop.

We all know that diet and nutrition play an integral part in our health.

The Feingold Diet is a common resource for parents who have children with ADHD, as well as adults who are looking to manage their ADHD. The diet was created by Dr. Ben F. Feingold, a prominent pediatrician and allergist, who was the Chief of Allergy at the Kaiser Permanente Medical Center in San Francisco. As he worked with patients he suspected of being sensitive to aspirin, he began to notice that they also reacted to some foods and food additives. He found, to his surprise, that not only did some people have physical reactions, but also many experienced changes in their behavior.

Although it is well known that stimulants like alcohol, caffeine, nicotine, and recreational drugs can affect behavior, most people don’t consider that food additives may have the same effect.

To treat hyperactivity in both adults and children, the Feingold Diet is centered on eliminating unnatural chemicals in food. Results have shown that Dr. Feingold’s diet has been able to help over 70% of his patients with hyperactivity.

This Nutritional Program has implemented his concepts in addition to the anti-inflammation nutrition this plan offers.

Food chemicals are not new, but years ago people were only exposed to them sporadically. Unfortunately, today’s population is exposed to harmful food chemicals every day, resulting in inflammation and metabolism disruption. In order to minimize the amount of chemicals you consume, be sure to purchase quality, all-natural, additive-free beef, poultry, seafood and produce. As mentioned before, consuming foods that will reduce inflammation including drinking a Hydroxide rich water * (see information in this article), raw fatty nuts, nut butters and seeds, avocados, dark berries, leafy greens and fatty fish like wild caught salmon.

The goal of a sound nutrition program working to reduce inflammation and symptoms of ADHD is to eliminate these additives:

Artificial (synthetic) coloring and dyes

Artificial (synthetic) flavoring

Artificial Sweeteners, All, including aspartame, saccharin, sucralose

Natural, PURE Stevia extract (be aware of substitutes like Truvia etc.)

Artificial (synthetic) preservatives BHA, BHT, TBHQ, MSG (which is also disguised as “yeast extract” in foods on labeling

In further research, some doctors have concluded that while not everyone with ADHD are deficient in omega-3 fatty acids, the addition of omega-3 fatty acids to the diet may be important. (10)

For those who wish to utilize omega-3 fatty acids as a method of modifying behavior, they should use both flax and seafood sources of these omega-3 fatty acids.

DHA — a vital omega-3 fatty acid — is found in abundance in seafood and fish oil supplementation, and appears to be helpful in modifying the behavior of those with ADHD.

It’s now well accepted that modifying the diet of those afflicted with ADHD can greatly help control the symptoms.

 

Foods to include in daily nutrition: Omega 3 fatty acids from walnuts, wild caught salmon and avocados.

Foods to Avoid: coffee, sport drinks/juice, candy and gluten.

ADHD Nutrition Plan

MEAL

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

SUNDAY

BREAKFAST

1-2 c stable alkaline water

Steel cut oats *

Southwest Egg Scramble*

Warm Blueberry breakfast cereal *

Banana nut crunch cereal*

Banana crunch cereal*

Oat flour pancakes*

Sweet potato Apple pie muffin*

SNACK

1-2 c stable alkaline water

¼ c Brazilian Nuts

Apple with almond or cashew butter

Coconut yogurt (none dairy)

1 serving Low sugar fruit- berries, apple, plum, grapes

Apple with almond or cashew butter

1 serving Low sugar fruit- berries, apple, plum, grapes

¼ c Brazilian Nuts

LUNCH

1-2 c stable alkaline water

Lettuce wraps- romaine lettuce with veggies and roast beef and salad dressing

Meatball squash boats*

Grilled chicken tossed salad with balsamic vinegar and oil.

Broccoli slaw* and grilled chicken breast

Lettuce wraps- romaine lettuce with veggies and roast beef and salad dressing

Carrot slaw* and grilled chicken breast.

Sweet potato hash*

SNACK

1-2 c stable alkaline water

Orange

Coconut dairy free yogurt

Celery or apple with nut butter (no sunflower)

Plum

1 serving low sugar fruit

¼ c nuts (no pine or sunflower seeds)

Celery or apple with nut butter (no sunflower)

DINNER

1-2 c stable alkaline water

Siracha lime salmon* with roasted asparagus

Faux chicken strips* and sweet potato fries*

Meatball sliders and side salad*

Chipotle chicken tacos*

Apple glazed pork chops and roasted carrots*

*meatloaf cupcakes

Almond crusted tilapia* with roasted cauliflower mash and green beans.

REFERENCES

  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.
  • Ogdie MN, Macphie IL, Minassian SL, Yang M, Fisher SE, Francks C, Cantor RM, McCracken JT, McGough JJ, Nelson SF, Monaco AP, Smalley SL. A genome-wide scan for attention-deficit/hyperactivity disorder in an extended sample: suggestive linkage on 17p11. Am J Hum Genet. 2003 May;72(5):1268-79.
  • Brain differences between persistent and remitted attention deficit hyperactivity disorder, Aaron T. Mattfeld, John D.E. Gabrieli, Joseph Biederman, Thomas Spencer, Ariel Brown, Amelia Kotte, Elana Kagan, Susan Whitfield-Gabrieli. Brain May 2014, awu137; DOI: 10.1093/brain/awu137

 

        1. Catecholamines and cognition after traumatic brain injury. Peter O. Jenkins, Mitul A. Mehta, David J. Sharp (2016) aww128 DOI: http://dx.doi.org/10.1093/brain/aww128 aww128 First published online: 2 June 2016
        2. Schou Andreassen C, Billieux J, Griffiths MD, et al. The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: a large-scale cross-sectional study. Psychol Addict Behav. 2016;30:252-262.
  • Thomas W. McDade. Biological Embedding of Early Social Adversity: From Fruit Flies to Kindergartners. Sackler Colloquium – Colloquium Paper – Biological Sciences – Anthropology: Early environments and the ecology of inflammation PNAS 2012 109 (Supplement 2) 17281-17288; published ahead of print October 8, 2012, doi:10.1073/pnas.1202244109
  • Vojdani A, Bautista J. Intestinal and blood-brain barrier: Interface between health and diseases. Functional Neurology, Rehabilitation, and Ergonomics, 2(3): 277-297, 2012.
  • Aristo Vojdani and Jama Lambert. Crossing barriers – Gut-to-Brain Lessons from Interdisciplinary Collaboration. Functional Neurology and Immunology: VI (pp. 631-644)

 

        1. S.M. O’Mahony, G. Clarke. Serotonin, tryptophan metabolism and the brain-gut-microbiome axis. Behavioural Brain Research Volume 277, 15 January 2015.

(10) International Conference Gives Boost to Including Omega Fatty Acids in Diet

 

JAMA. 1990;263(16):2153-2154. doi:10.1001/jama.1990.03440160015006.

(11)Waldman ID, Association and linkage of the dopamine transporter gene and attention- deficit hyperactivity disorder in children: heterogeneity owing to diagnostic subtype and severity. Am J Hum Genet 1998;63:1767-76.

(12) Kristine Yaffe MD: Alka Kanava MD;Karla Lindquist, MS: Elanor M. Simonsick PhD; Tamara Harris,MD; Ronald I. Shorr MD;Frances A.Tylaysky,PhD; Anne B. Newman,MD,MHP

JAMA. 2004;292(18):2237-2242. Doi:10.1001/jama292.18.2237

 

Resources

http://www.health.harvard.edu/newsletter_article/Diet-and-attention-deficit-hyperactivity-disorder

https://experiencelife.com/audio/grain-brain-an-interview-with-david-perlmutter-md/

http://feingold.org

http://psychcentral.com/lib/managing-adhd-with-diet/

http://www.integrativepsychiatry.net/brain_inflammation.html