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Natural Treatments for ADHD - December 7th, 2016 - Saint Marys Hospital

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This lecture, presented December 7th, 2016 for the Parent Support Group for children with ADHD and Sensory Processing Disorders, was presented at Saint Marys Hospital in Evansville, Indiana. In this one hour presentation, Dr. Cady broke down some of the alternative treatments for ADHD, grounded in the peer-reviewed literature, that do not involve the prescription of typical psychiatric medication for ADHD. He emphasized, natural, holistic treatments to treat deficiencies and restore balance of nutrients and specific essential fatty acids.

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Natural Treatments for ADHD - December 7th, 2016 - Saint Marys Hospital

  1. 1. Louis B. Cady, MD, FAPA – CEO & Founder – Cady Wellness InstituteLouis B. Cady, MD, FAPA – CEO & Founder – Cady Wellness Institute Adjunct Clinical Lecturer – Indiana University School of Medicine Department of Psychiatry Functional & Integrative Neuropsychiatry – Evansville, Indiana The Natural Treatment of ADHD: New Hope and New Directions Presented at: ADHD/SPD Parent Support Group Saint Marys Hospital – Evansville, IN December 7, 2016
  2. 2. Prevalence: how much, and “why so much”?
  3. 3. Increased methylphenidate usage for attention deficit disorder in the 1990’s. Safer DJ et al. Pediatrics. 1996 Dec; 98(6 Pt 1):1084-8} • 2.5 X increase in MPH tx between 1990 and 1995 – 2.8% (1.5 million) US youths aged 5-18 received this medication in mid-1995 • “The increase in methylphenidate…appears largely related to – an increased duration of treatment; – More girls, adolescents and inattentive youths on the medication – And a recent improved public image of medication treatment.”
  4. 4. www.billfoster.com - Reviving American Manufacturing, accessed 1 27 2014www.billfoster.com - Reviving American Manufacturing, accessed 1 27 2014
  5. 5. http://www.scdigest.com/assets/newsViews/08-06-12-2.php accessed 01 27 2014http://www.scdigest.com/assets/newsViews/08-06-12-2.php accessed 01 27 2014
  6. 6. Unemployment, underemployment are contemporary problems…
  7. 7. Genetic tendencies in ADHD
  8. 8. Faraone SV et al. Biol Psychiatry 2005 June 1;57(11):1313- 1323. Graphic from CNS Spectr. 2007;12:4 (Suppl 6): 6- 7
  9. 9. Genetic etiologies • Genes most commonly associated with ADHD involve dopamine. – Faraone SV, Perlis RH, Doyle AE, et al. Molecular genetics of attention- deficit/hyperactivity disorder. Biol Psychiatry. 2005;57:1313-1323. • PET studies show excess DAT into presynaptic neuron (15% higher than in controls) – Spencer TJ, Biederman J, Ciccone PE, et al. PET study examining pharmacokinetics, detection and likeability, and dopamine transporter receptor occupancy of short- and long-acting oral methylphenidate. Am J Psychiatry. 2006;163(3):387-395.
  10. 10. What does it “look like”? A section for kinesthetic and visual learners…
  11. 11. ADHD – not concentrating Inferior Orbital pre-frontal cortex Images courtesy of Daniel Amen, MD – Amen Clinics, Inc., Newport Beach, CA
  12. 12. ADHD - concentrating
  13. 13. ADHD – concentrating, on RX
  14. 14. ADD – inattentive, without Rx ADD – inattentive, on Amph Images courtesy of Daniel Amen, MD – Amen Clinics, Inc., Newport Beach, CA
  15. 15. Integrated: how to avoid over-reliance on meds • Holistic treatment and supplementation! – Cf: The Physician in Spite of Himself, Part II • Smart prescribing! • School: – Excellent working relationships with school – Good teaching • HOME: – Diminish “electronic screens” effect – Good home discipline – Good sleep/wake schedules – Good diet – Adequate exercise • Parent training: parenting, stress tips
  16. 16. What happened to those, anyway?!What happened to those, anyway?! New Concepts in the Epidemiology, Diagnosis and Precision Treatment of ADHD in Children, Adolescents, and Adults IMMH 5th Annual Conference San Antonio, TX Sunday, Sept. 21 But what about the functional medicine aspects??
  17. 17. My Previous Notion of Therapeutic Options
  18. 18. My experience with a child with out of control ADHD - the story of Billy • 8/1998 – 4 yo Eastern European adopted child – “ADD & behavioral problems, destructive.” – First 3 years of life in orphanage • Fam Psych Hx: – Dad – “substance induced paranoid psychosis” – Mother – “recurrent schizophrenic decompensations”
  19. 19. Billy, cont. • Some improvement • 3/1999 – increasingly vile temper. Sad, dysphoric. “Back to square one.” – Zoloft added. – Ritalin only lasting 1 ½ hours • 5/1999 - 4 ½ yoa. Rehab Center testing: – Auditory comprehension = 2 y 11 mo’s – Total language = 2 y 11 mo’s • 6/1999 – Flaxseed oil, L-tyrosine, Pediactive tabs added. In constant trouble Dad getting depressed.
  20. 20. Billy, cont – 1999 - 2000 • Ritalin and Adderall not working • Temper to the point of clawing at his face. Sniffing. Now urinating in bed. • 12/1999 – started on Risperdal – 1mg in a.m. and ½ mg later in day • 2/2000 – Psych testing – IQ 78 – ADHD – Borderline intelligence – Processing problems – “r/o childhood psychosis”
  21. 21. Billy, late 2000 • Fall 2000: – Bit and stabbed his teacher with a pencil, kicked chair, wall, and desk, spat on floor and teacher. Obsessively lining up his cars in his room, tongue thrusting and smacking (? Tardive dyskinesia?) • On Risperdal, Depakote, and Concerta. • 8/2001 – 2002 some better but still unpredictable. Meltdowns. Depakote increased. Zyprexa added. • 8/2002 – throwing things against windows. Depakote not working. Mood cycling.
  22. 22. Billy, 2003 • Ongoing unpredictability until Geodon started. – Less hyper – Dry in a.m. – Clearer speech and better eye contact. • July 2003 – IgG food allergy testing ordered
  23. 23. Billy – IgG Food Sensitvities July 2003 • 21 + IgG reactions.. Of these….. – Cheese (3+) – Cow’s milk (3+) – Goat’s milk (2+) – Brewer’s yeast (3+) – Millet (+1) – Lettuce (!) (+1) Reviewed labs with internet savvy Mom (who did NOTHING).
  24. 24. June 7, 2004 – 6 years of tx; ONE YEAR AFTER IgG Testing! • “Literally bouncing off the walls in the a.m.” • Almost knocked brother off second floor balcony • Could not tolerate < 2 g VPA • Threw stool over banister and tried to hit Mom on way up stairs. (Missed) • Told Mom: “You’re going to die, I’m going to make sure you’re going to die.” • Things that make him angry: not putting peanut butter sandwich on plate “correctly.” • Waking up screaming. Making non-human, guttural sounds. • Parents pursuing IP treatment
  25. 25. Radical interventions/ workup • June 2004 – Lithium added – Made him briefly toxic but symptoms improved. – Worked on getting him inpatient tx. • Fatty acid panel ordered. • Told Mom to GET SERIOUS about food allergies/sensitivities
  26. 26. Clinical manifestations of EFAD • Dermatitis • Increased appetite and caloric intake in infants (adults?!) • Failure of wound healing • Irritability • Alopecia, dry hair, dandruff • Brittle nails • Increased susceptibility of infections • Thirst, polydipsia, polyuria • Liver fatty infiltration • Increased capillary fragility • RBC fragility • Increased Cholesterol/HDL ratio
  27. 27. Essential Fatty Acid findings Value Reference range EPA 3 (L) 20 - 80 DHA 32 (L) 70 - 150
  28. 28. FEB 2005
  29. 29. • The present study found that 53 subjects with ADHD had significantly lower concentrations of key fatty acids in the plasma polar lipids (20:4n-6, 20:5n-3, and 22:6n-3) and in red blood cell total lipids (20:4n-6 and 22:4n-6) than did the 43 control subjects • “…but the precise reason for lower fatty acid concentrations in some children with ADHD is not clear.” • The present study found that 53 subjects with ADHD had significantly lower concentrations of key fatty acids in the plasma polar lipids (20:4n-6, 20:5n-3, and 22:6n-3) and in red blood cell total lipids (20:4n-6 and 22:4n-6) than did the 43 control subjects • “…but the precise reason for lower fatty acid concentrations in some children with ADHD is not clear.”
  30. 30. • “We argue that a change in the ratio of n-6/n-3, especially during early life, may induce developmental changes in brain connectivity, synaptogenesis, cognition and behavior that are directly related to ASD.” • “We argue that a change in the ratio of n-6/n-3, especially during early life, may induce developmental changes in brain connectivity, synaptogenesis, cognition and behavior that are directly related to ASD.”
  31. 31. • Western diet: omega 3 fatty acid deficiency and increased fructose intake. • “Both promote brain insulin resistance and increase the vulnerability to cognitive dysfunction.” • “Multiple cognitive domains are affected by metabolic syndrome in adults and in obese adolescents, with volume losses in the hippocampus and frontal lobe, affecting executive function.” • Western diet: omega 3 fatty acid deficiency and increased fructose intake. • “Both promote brain insulin resistance and increase the vulnerability to cognitive dysfunction.” • “Multiple cognitive domains are affected by metabolic syndrome in adults and in obese adolescents, with volume losses in the hippocampus and frontal lobe, affecting executive function.” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775234/
  32. 32. • In Adults with ADHD: • DECREASED DHA, AA, and DHGLA • “We could demonstrate that a lack of polyunsaturated FAs in blood serum of subjects with ADHD persists into adulthood. Furthermore, we could show that adult ADHD symptomatology positively correlates with elevated levels of saturated stearic and monounsaturated FAs.HGLA were lower than controls.” • In Adults with ADHD: • DECREASED DHA, AA, and DHGLA • “We could demonstrate that a lack of polyunsaturated FAs in blood serum of subjects with ADHD persists into adulthood. Furthermore, we could show that adult ADHD symptomatology positively correlates with elevated levels of saturated stearic and monounsaturated FAs.HGLA were lower than controls.”
  33. 33. Reduced Levels of Omega-3 Fatty Acids are Associated with ADHD Antalis et al., Prostaglandins Leukot Essent Fatty Acids, 2006. 75(4-5): p. 299-308.
  34. 34. This summary demonstrates that a deficiency in brain PUFAs will lead to cognitive deficits, while supplementation of PUFAs can rehabilitate cognitive deficits, as manifested in attention deficit hyperactivity disorder, stress/anxiety, and aging. This summary demonstrates that a deficiency in brain PUFAs will lead to cognitive deficits, while supplementation of PUFAs can rehabilitate cognitive deficits, as manifested in attention deficit hyperactivity disorder, stress/anxiety, and aging.
  35. 35. Should we use this??
  36. 36. Further elongation problems: lack of nutrients • REQUIRED for delta-6 desaturase: – Magnesium – Zinc – B vitamins • FAD (B2) • Niacin (B3) • P-5-P (B6) – C – insulin “chiropractic” “psychiatric”
  37. 37. Extra slide of online viewing • Key principles of essential fatty acid supplementation are: – Do not use large doses of a generic omega 6 or omega 3 fish oil and presume that you are going to get adequate amounts of EPA and DHA out the bottom of the pathways. – The only two sources of fish oil high in PUFA’s that we get are from eating fish or taking fish oil. Period. If we don’t eat fish, we should probably be on fish oil. – We DO have the ability to synthesize the critical PUFA’s, including EPA and DHA, from precursors, but in order to do so, we must have adequate amounts of the critical trace minerals.
  38. 38. Vayarin – a new prescription “medical food” – the theory behind development • Lipids are important for brain health • Abnormal lipid balances are associated with ADHD. • Lipid levels (in blood and brain) might be affected by different parameters (e.g., diet, metabolism) • Therefore, why not put more of the good lipids into the brain?
  39. 39. Polar head Fatty acids Phosphate group Glycerol backbone Phospholipid molecule omega-3 Fatty acids
  40. 40. Vaisman, N. et al., Progress in Neuro-Psychopharmacology & Biological Psychiatry, 2009: p. 952-959. What’s the best way to get Omega 3 into mouse brain?
  41. 41. NOTE: The essential elements portion of this test include: •Elemental lithium •Iron •Magnesium •Zinc •copper NOTE: The essential elements portion of this test include: •Elemental lithium •Iron •Magnesium •Zinc •copper
  42. 42. IRON - Most common of all nutrient deficiencies in U.S. school-aged children Murray & Pizzorno. Encyclopedia of Natural medicine. Rocklin, CA: Prima Publishing; 1998. • Deficiency associated with: markedly decreased attentiveness, narrower attention span, decreased persistence, and lowered activity level – all of which respond positively to supplementation. • Kidd. ADHD in Children: Rationale for Its Integrative Management. Alt Med Review 2000; 5(5):402-427. • 30% improvement in Conners ADHD Rating Scale following iron supplementation [(Ferrocal), 5 mg/kg/day for 30 days] in one uncontrolled Israeli study of boys. • Sever et al. Iron treatment in children with attention deficit hyperactivity disorder. A preliminary report. Neuropyshcobiology 1997;35:178-180. 0 5 10 15 20 25 30 35 40 45 serum ferritin Conners before after –significant increase in serum ferritin levels (from 25.9 +/- 9.2 to 44.6 +/- 18 ng/ml) and a significant decrease on the parents' Connors Rating Scale scores (from 17.6 +/- 4.5 to 12.7 +/- 5.4).
  43. 43. Zinc link --- and friends • Psychiatr Pol 1994 May-Jun;28(3):345-53 [Deficiency of certain trace elements in children with hyperactivity] [Article in Polish]Kozielec T, Starobrat-Hermelin B, Kotkowiak L. Zakladu Medycyny Rodzinnej Pomorskiej Akademii Medycznej. • The magnesium, zinc, copper, iron and calcium level of plasma, erythrocytes, urine and hair in 50 children aged from 4 to 13 years with hyperactivity, were examined by AAS. The average concentration of all trace elements was lower compared with the control group--healthy children from Szczecin. The highest deficit was noted in hair. • Our results show that it is necessary to supplement trace elements in children with hyperactivity.
  44. 44. Magnes Res 1997 Jun;10(2):143-8 Kozielec T, Starobrat-Hermelin B.,, 1997, cont. • 116 children with ADHD • Magnesium deficiency was found in 95 per cent of those examined: – most frequently in hair (77.6 per cent) – in red blood cells (58.6 per cent) – and in blood serum (33.6 per cent) • CONCLUSIONS: magnesium deficiency in children with ADHD occurs more frequently than in healthy children. Analysis of the material indicated the correlation between levels of magnesium and the quotient of development to freedom from distractibility.
  45. 45. Putting it all together with new technology… Two illustrative cases
  46. 46. The adorable rager – parents concerned; interested in natural treatment • Clinical details removed for internet post
  47. 47. THEREFORE: informed treatment decisions • Diet – eliminate dairy and wheat • L-Methylfolate support to bypass MTHFR • Vayarin for membrane stabilization • 5HTP to supply more raw material for serotonin synthesis • Lithium – 10 drops = 0.5 mg
  48. 48. “Nothing but marijuana makes me happy” – 14 yoa • Clinical details removed for internet posting
  49. 49. Antioxidant assessment Reference: www.cadywellness.com/cadyw Reference: www.cadywellness.com/cadyw
  50. 50. (c) 2013 Louis B. Cady, M.D. - all rights reserved
  51. 51. Search – 12/7/2016 1:51 pm
  52. 52. Search – 12/7/2016 1:54 pm
  53. 53. treatment decisions • Enlyte – (L-methylfolate plus methylate Bvitamins and trace iron) • Based on other labs: – Selenium and magnesium – Low dose thyroid (T3) • Ultra low dose Bupropion if needed to be started in 2 – 3 weeks.
  54. 54. “Don’t think ‘either/or.’ Think ‘both/and.’” - Dan Burrus
  55. 55. “There are things known and there are things unknown, and in between are the doors.” - Jim Morrison
  56. 56. Contact information: Louis B. Cady, M.D. www.cadywellness.com www.tmsrelief.com Office: 812-429-0772 E-mail: lcady@cadywellness.com 4727 Rosebud Lane – Suite F Interstate Office Park Newburgh, IN 47630 (USA)

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