Attention deficit hyperactivity disorder, Walsh Research Institute, Nutrient therapy

Advanced Nutrient Therapy For ADHD, Mood and Behavioral Disorders

By Dr. Jason Loken, ND, DOMP, RMT, PhD (cand)

There is no debate that attention deficit and hyperactivity disorder (ADHD) diagnoses have skyrocketed over the past decade, but why? Are we really living in a time where such a large percentage of our children are unable to manage their behavior, their temperament, their focus, their impulsivity, and their ability to learn?

Let’s take a look at the prevalence of ADHD diagnoses in the United States. According to the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013), 5% of children have ADHD.¹ However, other studies in the US have estimated much higher numbers. For example, in a 2016 Centers for Disease Control and Prevention study, scientists found that 6.1 million children (9.4%) aged 2-17 years living in the US had been diagnosed with (ADHD).²

In a recent study published in 2018, researchers reviewed data on 186,457 children and adolescents aged 4 to 17 years. The data was collected from the National Health Interview Survey, an in-person interview that the Centers for Disease Control and Prevention conducted annually from 1997 to 2016. It was found that the rate of ADHD diagnoses in this group of children and adolescents rose from 6.1% in 1997-1998 to 10.2% in 2015-2016.³

Between 2003 to 2011 the prevalence of ADHD increased by 42%,⁴ with increases in nearly all demographic groups in the United States regardless of race, sex, and socioeconomic status. Eleven percent of school-age children in the United States now meet the criteria for the diagnosis of ADHD; one in five boys and one in 11 girls meet the criteria.⁴

There is no question that the data supports a dramatic increase in the prevalence of ADHD but why? In my opinion there are generally three accepted explanations for the explosion of ADHD diagnosis over the past two decades. These explanations include the following:

1. An increased awareness of ADHD and better case finding.

2. An over diagnosis and misdiagnosis of ADHD based on heuristics, unclear rules of thumb, rather than adhering to recognized diagnostic criteria. Boys in particular are substantially more often misdiagnosed compared to girls.⁵

3. A real problem due to factors that are affecting our children’s health and making them sicker and more susceptible to ADHD.

Although there is much debate as to which of these factors or combination thereof are responsible for the rise in ADHD diagnoses, what I can tell you is that, clinically I have seen a significant increase over the past 17 years in the number of children I see that do have challenges managing their behavior and attention. I have also spoken with many teachers who have been in the field for fifteen to twenty years or more who often tell me exactly the same thing. So, what’s in the proverbial water that’s impacting all of our kids in such a negative way?

There is an ever-growing list of theories for the rise in ADHD. You may have heard everything from changes in home and family dynamics and parenting, both parents working, less focused attention to our children, the increase in screen time, and the fast-paced nature of our modern world, the refinement of our foods, the increases in chemicals, GMOs, glyphosate, sugar, and the ever increasing food sensitivities we see.

We also can’t forget the sedentary nature of our kids’ lives, less physical activity, obesity, video games, the increase in EMF pollution, as well as the substantial increase in vaccinations. This potential list of possible contributing factors could go on and on depending on which expert you decide to talk to.

What I have become extremely curious about over the past several years in regards to ADHD is whether or not there are any measurable changes in the pathways that govern how people think, feel, and act—in a nutshell, our brain chemistry. The problem I kept coming up with was finding a reliable way to clinically assess which pathways were out of balance, why they were out of balance, and ultimately how to correct it so these children can get their brain chemistry back in check and improve the trajectory of their life.

It was about four years ago that I was sitting in my car listening to a podcast on Bulletproof Radio. Dave Asprey was interviewing a legend in the world of orthomolecular psychiatry, Dr. William Walsh of the Walsh Research Institute (WRI). I was elated when I heard Dr. Walsh talk about the biochemical therapy that the WRI teaches doctors. Dr. Walsh’s research suggests that mental illnesses are largely epigenetic in origin. It has been discovered that environmental factors such as toxic exposures and nutrient imbalances can cause genes to express themselves improperly and influence many psychiatric disorders.⁶ Research in epigenetics has discovered several nutrients that have profound effects on the transporters at neurotransmitter synapses leading to too little or too much neurotransmitter available.^7,8

The WRI is founded on over 35 years of clinical research and a massive database containing millions of chemical factors in blood, urine, and tissues in patients challenged by behavior disorders, ADHD, autism, anxiety, depression, bipolar disorders, schizophrenia, and Alzheimer’s disease. There are over 1.5 million chemical assays from testing over 10,000 patients with behavioral disorders and 5,600 patients with ADHD alone.^9,10 It has been discovered that approximately 90% of these individuals have significant imbalances in brain chemistry that can often be corrected using advanced nutrient therapy. By the end of the podcast I had already contacted the Walsh Research Institute and signed up for my first practitioner-training program.

Advanced nutrient therapy offers an alternative treatment approach to pharmaceutical medications. Through the targeted prescription of vitamins, minerals, and amino acids, a natural method of correcting imbalances in neurotransmitter activity can be attained.  The clinical challenge is to determine biochemistry of each patient and to develop an individualized treatment plan aimed at normalizing brain chemistry.  For most patients, the benefits of advanced nutrient therapy result from the following¹¹:

• Normalizing the concentration of nutrients needed for neurotransmitter synthesis;

• Epigenetic regulation of neurotransmitter activity; and

• Reducing free radical oxidative stress.

What I have found most impactful from this training is that we can now narrow down with accuracy which pathways are not functioning properly and, with precision, know how to treat it with targeted nutritional therapy. In order to do this, a detailed clinical intake is required as well as specific labs through blood and urine. Both the clinical symptoms and labs are weighted equally in making the diagnosis. There can be several different imbalances, sometimes referred to as biotypes, at play causing a child to display behavioral and ADHD symptoms. Each biotype is treated uniquely; this is why it is vastly important to figure out the root imbalance. For example, when we look at ADHD there are actually seven different chemical imbalances that are often at the root of the problem.¹⁰ According to an outcome study from 2004,¹² involving 207 patients diagnosed with a behavioral disorder at the Pfeiffer Treatment Center over a 10-year period the imbalances discovered were as follows:

1. Elevated copper/zinc ratio: 75.4%

2. Overmethylation: 29.5%

3. Undermethylation: 37.7%

4. Pyrrole disorder 37.7%

5. Heavy metal overload: 17.9%

6. Glucose Dyscontrol: 30.4%

7. Malabsorption: 15.5%

A child may have any one or combination of them. Each biotype has its own set of unique symptoms based on the way that it is affecting brain chemistry.

According to the WRI some of these imbalances affect brain chemistry in the following ways.¹⁰ An elevated copper:zinc ratio can lead to depleted levels of dopamine and elevated levels of norepinephrine causing symptoms such as episodic rage, poor attention, and hyperactivity. A pyrrole disorder may cause a severe deficiency of zinc and B6 leading to decreased levels of serotonin and dopamine causing the child to have symptoms such as poor stress control, sensitivity to lights and sounds, and explosive anger. Undermethylated individuals, aka histadelia, have too little methyl and will have elevated blood histamine and low serotonin levels. They are more likely to suffer with symptoms such as depression, perfectionism, seasonal allergies, defiance, and obsessive-compulsive tendencies. Whereas overmethylated, aka histapenia, patients would have low histamine and elevated levels of dopamine, serotonin, and norepinephrine and be more prone to anxiety, panic attacks, paranoia, and depression. All of these patients may be diagnosed with ADHD, but the treatment is unique to the underlying biochemistry that is out of balance. Not only can the improper treatment be useless, it could aggravate the condition and make things far worse.

I love this approach because it is very individual, systematic and clinically reliable. In my opinion every child struggling with symptoms of ADHD or a behavioral disorder should get tested first to see if there are any brain chemistry imbalances at the root of the problem. For certain biotypes, medications such as Ritalin or a serotonin reuptake inhibitor may be quite effective; for others it could be devastating. If we understand the root imbalance, we can often address the underlying cause through nutritional therapy with little to no side effects.

The research suggests that there are a number of factors, both biophysical and psychosocial that can have a powerful influence on epigenetic tags and disease susceptibility.^13-15 For example, emotional or physical trauma, nutritional imbalances, and toxin exposure may all alter epigenetic gene expression potentially setting in motion brain chemistry imbalances. Once the epigenetic imbalance has been established, we need to assist the patient in switching it back off. Advanced nutrient therapy is a very viable solution for ADHD, mood and behavioral imbalances that may be epigenetic in origin.

I am a firm believer in the need for good parenting and a loving environment, teaching kids ways to self-regulate, getting them to move their bodies and become more active, and eating healthy foods; yet if there is a chemical imbalance, all of these strategies are limited. For example, imagine being asked to do mindfulness techniques or cognitive/behavioral therapy if your body is biochemically elevating your norepinephrine levels, or if you don’t have enough serotonin or dopamine to actually focus or feel good; it is virtually impossible. Once the underlying imbalance is supported then the child can more fully embrace all of these wonderful strategies and move towards a life that is much less struggle and much more fulfilling.

References

Association, A. P. (2013). Diagnostic and Statistical Manual fo Mental Disorders: DSM-5 (5 ed.). Washington: American Psychiatric Association.Danielson ML, et al. Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. J Clin Child Adolesc Psychol, 2018;47(2), 199-212. Xu G et al. Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016. JAMA Netw Open, 2018;1(4), e181471.Visser SN, et al. Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. J Am Acad Child Adolesc Psychiatry. 2014; 53(1), 34-46 e32. Merten, EC, et al. Overdiagnosis of mentaldisorders in children and adolescents (in developed countries). Child Adolesc Psychiatry Ment Health. 2017;11, 5.Tsankova N, et al. (2007). Epigenetic regulation in psychiatric disorders. Nat Rev Neurosci. 2007; 8(5), 355-367. Avalos JL, Bever KM, Wolberger C. Mechanism of sirtuin inhibition by nicotinamide: altering the NAD(+) cosubstrate specificity of a Sir2 enzyme. Mol Cell. 2005; 17(6), 855-868. Luka Z, et al. Histone demethylase LSD1 is a folate-binding protein. Biochemistry. 2011; 50(21), 4750-4756. Crayton JW, Walsh WJ. Elevated serum copper levels in women with a history of post-partum depression. J Trace Elem Med Biol. 2007;21(1), 17-21. Walsh WJ. Nutrient Power, Heal your Biochemistry And Heal Your Brain. New York: Skyhorse Publishing; 2012.Hambly JL, et al. Micronutrient Therapy for Violent and Aggressive Male Youth: An Open-Label Trial. J Child Adolesc Psychopharmacol. 2017; 27(9), 823-832. Walsh WJ, Glab LB, Haakenson ML. Reduced violent behavior following biochemical therapy. Physiol Behav. 2004;82(5), 835-839. Dolinoy DC, Jirtle RL. Environmental epigenomics in human health and disease. Environ Mol Mutagen. 2008;49(1): 4-8. Dolinoy DC, Weidman JR, Jirtle RL. Epigenetic gene regulation: linking early developmental environment to adult disease. Reprod Toxicol. 2007;23(3): 297-307.Jirtle RL, Skinner MK. Environmental epigenomics and disease susceptibility. Nat Rev Genet. 2007; 8(4), 253-262.

SIDEBAR

Case Report of a 12-Year-Old Male Diagnosed with ADHD and Anxiety Disorder

Primary symptoms:

• Diagnosed with anxiety disorder and ADHD;

• Doctor wanted to put him on stimulant medication to assist with ADHD symptoms;

• Extremely poor stress control;

• Very sweet kind child most of the time;

• Extreme mood fluctuations often triggered by stress, changes in routine, and socially fitting in at school;

• Academic underachievement;

• High anxiety, addicted to video games and screens;

• Began biting himself and self-harming when he was in a meltdown;

• Very sensitive and emotional child;

• White spots on fingernails.

This child has a very sweet disposition with caring parents. It was suggested by his GP to start a trial of Ritalin for ADHD and see how he improves. The parents wanted to try other treatment options first before resorting to medications.

His diet has been well balanced, and he has a good appetite other than morning nausea on occasion. He seemed to be generally sensitive to brighter lights and gets overwhelmed and distracted when there are more stimuli in a room such as noises, lights, and additional people. He was very sensitive to the feelings of others and picks up quickly on the emotional climate around him. He loves animals and finds much comfort just playing with his dog.

Lab Results

Initial lab results revealed that this patient had several imbalances at the same time. He had extremely low levels of zinc, was overmethylated, and had very high levels of pyrroles.

Pyrroles are assessed through a urine test and done at a specific lab that is very familiar with testing pyroluria. Normal levels are between 0-10 and his levels were 93.79. This was a very elevated level and likely the reason for his very low zinc levels. Levels this high it would make it virtually impossible for him to be able to self-regulate, and he probably had never known what is has felt like to be calm in his body.

Treatment

The main treatment to address the elevated pyrrole included zinc picolinate and high levels of B6 and P5P, vitamin C, selenium as well as biotin, borage oil, and vitamin E.

The treatment for overmethylation included niacinamide, folinic acid, and sublingual B12.

Once treatment started the biggest difficulty was consistency with the nutrient therapy; but once the family got into a routine, he was able to commit to a relatively consistent daily schedule.

The family started to notice that within a month his stress response was improving. He was no longer biting or hurting himself; his episodes that were described as severe meltdowns started to be less intense and less frequent. His social anxiety at school decreased, and he was interacting in more social events, including hip hop classes and performing at a school talent show. His ability to focus on schoolwork also started to improve little by little as the weeks and months went by. White spots on the fingernails disappeared, and medications were never required.

I encouraged the family to see an occupational therapist to assist with developing more social skills now that the biochemistry was more in balance.

It took a while to get his labs rechecked as this child had a strong aversion to getting needles; but when we re-checked his pyrrole levels, which was the main imbalance, his levels reduced from 93.79 down to 17.51. He still feels best when he is maintaining his regime of supplements. The dosages for the specific nutrients will vary depending on his future lab results.