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.

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

3. Prevalence: how much, and “why
so much”?

4. 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.”

6. www.billfoster.com - Reviving American Manufacturing, accessed 1 27 2014www.billfoster.com - Reviving American Manufacturing, accessed 1 27 2014

7. 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

9. Unemployment, underemployment are
contemporary problems…

10. Genetic tendencies in ADHD

11. Faraone SV et al. Biol Psychiatry 2005 June 1;57(11):1313-
1323.
Graphic from CNS Spectr. 2007;12:4 (Suppl 6): 6- 7

12. 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.

13. What does it “look like”?
A section for kinesthetic and
visual learners…

16. ADHD – not concentrating
Inferior Orbital pre-frontal cortex
Images courtesy of Daniel Amen, MD – Amen Clinics, Inc.,
Newport Beach, CA

17. ADHD - concentrating

18. ADHD – concentrating, on RX

19. ADD – inattentive, without Rx ADD – inattentive, on Amph
Images courtesy of Daniel Amen, MD – Amen Clinics, Inc., Newport Beach, CA

20. 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

21. 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??

22. My Previous Notion of Therapeutic Options

23. 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”

24. 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.

25. 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”

26. 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.

27. 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

28. 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).

29. 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

30. 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

31. 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

32. Essential Fatty Acid findings
Value Reference range
EPA 3 (L) 20 - 80
DHA 32 (L) 70 - 150

34. FEB
2005

36. • 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.”

37. • “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.”

38. • 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/

39. • 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.”

40. 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.

41. 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.

42. Should we use this??

43. 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”

44. 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.

45. 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?

46. Polar
head
Fatty
acids
Phosphate
group
Glycerol
backbone
Phospholipid molecule
omega-3
Fatty acids

48. 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?

50. 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

51. 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).

52. 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.

53. 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.

54. Putting it all together with new
technology…
Two illustrative cases

55. The adorable rager – parents
concerned; interested in natural
treatment
• Clinical details removed for internet post

63. 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

64. “Nothing but marijuana makes me
happy” – 14 yoa
• Clinical details removed for internet posting

67. Antioxidant assessment
Reference:
www.cadywellness.com/cadyw
Reference:
www.cadywellness.com/cadyw

68. (c) 2013 Louis B. Cady, M.D. - all
rights reserved

69. Search – 12/7/2016 1:51 pm

70. Search – 12/7/2016 1:54 pm

74. 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.

75. “Don’t think ‘either/or.’
Think ‘both/and.’”
- Dan Burrus

76. “There are things
known and there are
things unknown, and
in between are the
doors.”
- Jim Morrison

77. 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)