Supplements in ADHD Treatment

If you know any families that have children with ADHD you know how difficult it is to manage.  The medications have side effects, are expensive and difficult to use, and don’t always control symptoms well.  Is it any wonder there is such a big demand for supplements in ADHD treatment?

Families of kids with ADHD are desperate for treatments that work and are safe.  Fortunately there is good evidence for two supplements in ADHD treatment.

There is a well-written review I came across while looking up something for a patient.  Since I have so many readers with family members struggling with ADHD I thought I would summarize the review for you.

Basically there are only two supplements whose use has been proven to help children with ADHD.  Many, many supplements have been promoted for use to help with ADHD but the evidence is thin to nonexistent about their benefit.  Let’s talk about the two useful ones, then I’ll quickly go through the ones that need more investigation.

OMEGA-3 POLYUNSATURATED FATTY ACIDS

Omega-3 supplements have very good evidence to show they help children with ADHD   The American diet is very heavy on omega-6 fatty acids and when the ratio of omega-3 to omega-6 fatty acids isn’t properly balanced it can interfere with lots of different body functions.  Omega-6 fatty acids tend to be pro-inflammatory and omega-3 fatty acids are anti-inflammatory.

The component of fish oil that seems to be effective for ADHD symptoms is eicosapentaenoic acid (EPA).  Fish oil supplements vary widely in their content of EPA.  For instance, Shaklee’s OmegaGuard contains 363 mg EPA per two-capsule serving.  Nature Made’s burpless fish oil capsules have 180 mg EPA per two-capsule serving.  Carlson’s lemon-flavor liquid fish oil supplement contains 800 mg EPA per teaspoon.

I’ve written elsewhere that fish oil is healthy for everyone to take.  If you have a child with ADHD this is definitely one to add to their daily regimen.  Make sure to get as much EPA as possible, since that seems to be what is helpful for ADHD.

MELATONIN

Melatonin is used to help patients fall asleep.  It is a hormone produced in the pineal gland.  Production goes down when it is light out, and goes up when it gets dark.  It regulates our sleep-wake cycle.

Sleep disturbances are common in children with ADHD.  Melatonin has been studied for its ability to help children with ADHD fall asleep, sleep longer, sleep better, and manage their ADHD symptoms better.

Melatonin has been shown to be effective for helping children with ADHD fall asleep more easily.  However, the evidence for helping them sleep longer and better is not very strong.  And there is no evidence for melatonin helping kids with ADHD symptoms other than trouble falling asleep.

I found mention of a concern about children taking melatonin regularly having trouble with delayed onset of puberty.  It is known that in other mammals like rats, melatonin plays a role in the onset of sexual maturation, and administering melatonin to young animals can delay this onset.  However I was not able to find any studies addressing whether children using melatonin regularly are more likely to start puberty later than children who don’t take melatonin.  There certainly is no evidence of an ABNORMALLY late start to puberty in such children.

OTHER SUPPLEMENTS

Many other nutritional supplements are promoted to be helpful with managing ADHD.  Supplements such as iron, zinc and magnesium may be helpful in patients with documented deficiencies or dietary problems like malabsorption.  Ginkgo biloba has a modest effect, much less than that of medications, and has some serious side effects such as increased bleeding tendency.  Carnitine and St. John’s Wort are no better than placebo.

In summary, in spite of all the marketing hype around supplements for ADHD, there is really very little evidence that any but a few are effective.  If your child has ADHD they should definitely be on a high-quality fish oil supplement that gives them plenty of EPA.  If they have trouble falling asleep then a trial of melatonin would be reasonable with the approval of their doctor.

Until more research is published to show effectiveness of other supplements, unfortunately there is little reason to spend money on other supplements specifically to address ADHD.

QUESTION:  Do you have kids in your life struggling with ADHD?  Was this post helpful for you?

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Counting My Blessings

I’m sick today and running a fever.  Some yucky virus has got hold of me.  I was tempted just to sleep the day away but didn’t want to break my 3 1/2 year streak of weekly blog posts!

So I decided to just jot a few thoughts down for you.  When things aren’t going well or I’m under stress, I try to remind myself to count my blessings.  That always makes me feel better.

So what if I’m sick?  Well what’s so special about me, right?  Even doctors get sick sometimes.

I’m grateful for ibuprofen and Ricola cough drops.  Shaklee’s Defend and Resist.  My friend Elise’s bubbe’s amazing cure-all soup.  Friends like Donna who text to see how I’m feeling (lousy, but thanks for asking).

Most of all I’m grateful for the knowledge that this is only a bad viral bug and I will be on the mend in a few days.  Things could definitely be worse.

For those who haven’t been following, my mom was diagnosed with breast cancer in August and has been undergoing chemo.  She’s had a rough go of it with some complications.

Two weeks ago my mom had her mastectomy and then developed a bad wound infection, needing to be readmitted to the hospital for more treatment.

Even in this awful situation there is plenty to be grateful for.  My parents have a large community of close and loving friends in their small town.  (Dad jokes he has to buy a new freezer for all the food people keep bringing them.)

My sister and I are both in the medical field and we are both grateful for the excellent, compassionate care she has received from her doctors, nurses, and all the people involved in her care.

Most of all, we are grateful that she is still here with us, still fighting hard to get well.

I’m grateful for my husband and my boys who don’t bat an eye when I drop everything for a few days to spend time with my mom after her surgery.

I’m grateful for my office staff who also don’t bat an eye at the same absence.

I’m grateful for my faith that tells me not to worry, but to pray about everything and then be at peace.  (Philippians 4:6-7)

OK, St. Paul, that’s a tough one, but I’m working on it 🙂

QUESTION: What helps you when things aren’t going well?

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Treating High Blood Pressure

Blood pressure quality measures piss me off.  I just got a report about what portion of my patients’ blood pressures are at treatment goal and my numbers are lower than they should be.

Know why?

I have a lot of patients who have what is known as white coat hypertension.  That means that their blood pressure is higher at the doctor’s office than it is at home.  My own husband has mild white coat hypertension.

I strongly encourage my patients whose blood pressure is high in my office to monitor their blood pressure at home.  I need to know what their blood pressure is when they are not at the office.  They can monitor at different times of the day but the most important time to check is first thing in the morning.

What should blood pressure be?  The current recommendations are that patients less than 60 years old should be treated for blood pressures higher than 140/90, and if they are over 60 years old they should be treated if the blood pressure is over 150/90.  However, if a patient has diabetes they should be treated if the blood pressure is over 140/90 regardless of how old they are.

I have no trouble with these recommendations and I definitely practice this way.  I will keep working with my patients to get their blood pressure down until they are at goal.  The number one risk factor for stroke and a huge risk factor for heart attacks is uncontrolled high blood pressure.

My problem with the quality measures that the government requires of doctors is that they only take into account what a patient’s blood pressure is when they are at the doctor’s office.  So if my patient has white coat hypertension and tells me their blood pressure first thing in the morning at home is 125/70 (and they have a good reliable home blood pressure meter) it doesn’t really matter to me what it is when they are in the office.

If I treat white coat hypertension with the goal of meeting treatment goals AT THE OFFICE, the patient will be hypotensive (have low blood pressure) at home.  They will be dizzy and not feel well.  They may faint.  They will not tolerate exercise well.  Male patients will be more likely to have erectile dysfunction.

We know that, in the short term, low blood pressure is more dangerous than high blood pressure.  If I am not careful about making sure I right-size my treatment, I will hurt my patient.  I will take a patient who feels well and make them sick when it’s not needed.

On my first day of medical school I took an oath to do no harm.  To avoid both overtreatment and “therapeutic nihilism.”  To focus on prevention as well as treatment of disease.  And above all, to remember that I am treating a person, not a set of vital signs.

If you are my patient and I’m treating you for high blood pressure, please monitor your blood pressure at home.  Use a good-quality monitor (I bought an Omron meter for my hubby and me to use) and bring your log with you when you come to see me.  If I don’t have home blood pressure readings, the only info I have to use to manage your blood pressure is what I see at the office.  This is usually accurate, but may not be for certain patients.

We’re partners, both working to help you be as healthy as possible.  Watch your diet, make sure you’re getting enough magnesium (and supplement if you need to), control your stress and work on your physical fitness.

Treating high blood pressure, like all the rest of medicine, is more than just prescribing and taking pills.  There’s as much art as science involved, and we need to be mindful of the whole person existing everywhere, not just a set of vital signs obtained in the doctor’s office.  Done right, controlling blood pressure will reduce the risk of heart attack and stroke without causing side effects.

And that is much more important to me than a set of quality measures that judge how well I do my job.  How can looking at what percent of my patients have normal blood pressure at the time they’re in my office be a good measure of how well I care for them?

It isn’t.  So I don’t care.  What kind of doctor do YOU want?

QUESTION:  Do you monitor your blood pressure at home?  Is your blood pressure higher at the doctor’s office than it is at home?

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Why You Need Dietary Fiber

You know how you sometimes have a topic that seems to follow you around for a couple of days?  Several people mention it to you, you keep seeing it on the news, or a TV commercial keeps popping up?  I felt that way about dietary fiber this week, so obviously that meant I was supposed to write about it today!

I found myself telling people all week that they needed to add more fiber to their diet.  There are many reasons why your body needs dietary fiber.

Fiber is the stuff in food that can’t be broken down in our digestion.  It is found only in plant foods.  There are two kinds, soluble and insoluble, and both are important.

Soluble fiber absorbs water and turns into kind of a gel (like what happens to oatmeal when you cook it).  It not only absorbs water, but it soaks up other stuff too.  We’ll talk about that in a minute.  Insoluble fiber doesn’t absorb water, it provides bulk to stools and keeps you regular.

Why is dietary fiber important?  Let’s review 5 reasons.  If you can think of more, please comment at the end!

Dietary fiber keeps you regular

I’ve only experienced constipation once in my life and BOY was it uncomfortable!  Unless you have a medical cause for your constipation (like hypothyroidism or narcotic pain medicine use) in which you have to find and fix the cause, the treatment of choice for constipation is increased dietary fiber.

Both soluble and insoluble fiber help with bowel function.  Neither of them are absorbed in the digestion.  Insoluble fiber provides bulk and sweeps intestinal contents along.  Soluble fiber absorbs water and keeps stool soft and easier to pass.

Dietary fiber absorbs toxins

As I’ve written before, your liver is a workhorse for detoxifying stuff that you eat and drink.  After processing, the toxins are put into bile which then goes into the intestine.

Once in the intestine, one of two things can happen to the toxin.  It can be bound to dietary fiber, which keeps it harmless and takes it out in the stool.  Or it can be reabsorbed in the colon (which really functions to reabsorb water but can reabsorb lots of stuff with the water).

Being reabsorbed is really not what we want to happen to the toxic stuff in our intestine that the liver worked so hard to get rid of.

Dietary fiber lowers cholesterol

One of the other things that dietary fiber can absorb in the intestine is cholesterol.  Soluble fiber absorbs both cholesterol from the food we eat and also cholesterol the liver has put in the intestine.  Cholesterol is a major component of bile salts, a soapy substance that helps to break down dietary fat into little droplets that are easier to digest.

The bile salts can stick to the soluble fiber and be taken out in the stool.  This lowers the total amount of cholesterol in the body and helps to bring blood cholesterol levels down.  We’ll talk in a minute about what foods to eat to get more fiber in the diet.

Dietary fiber helps you lose weight

Yay for fiber!  By adding bulk without calories to your meals, dietary fiber keeps you full longer and suppresses appetite.  Also, high-fiber plant foods tend to be very nutrient-dense meaning they are full of vitamins, minerals and antioxidants without adding a lot of calories.

Dietary fiber feeds your intestinal bacteria

It turns out that the healthy bacteria in the intestine depend on dietary fiber for their food.  The types of bacteria in your intestine are heavily influenced by what foods you eat.  Eat a lot of “meat and potatoes” and you get one type of bacteria.  Eat a lot of plant foods rich in dietary fiber and you get a much healthier and more beneficial panel of microorganisms in the bacteria.

Think of your intestinal bacteria as travelers or tourists staying in your home.  If you want the right kind of visitors, you have to feed them what they like to eat.  Starve them and they will leave, and a different type of bacteria will move in.

Have I convinced you that dietary fiber is important?  Hope so, LOL!  Now let’s talk about how to get enough fiber.  First it’s helpful to find out how much fiber you’re taking in already.  There are lots of calorie trackers out there but my favorite is My Fitness Pal.  Not only does it tell you how many calories you’re eating, but it will tell you how many carbs, protein, fat grams and fiber grams you’re getting.

You don’t have to track forever, just long enough to get a baseline.  I recommend everyone gradually increase their fiber intake until they’re getting 30 grams of fiber per day or more.

How can you do that?  The best way is by eating more fiber-containing foods.  Some examples are oatmeal, whole grain bread products, beans, brown rice, and fresh fruits and veggies.  Make sure to add fiber slowly over several weeks to meet your goal, and drink plenty of water.

Some people who can’t get a lot of fiber (because they take Coumadin and aren’t able to eat a variety of fresh fruits and green leafy vegetables, for instance) need a fiber supplement.  This is OK, just make sure your supplement doesn’t contain artificial food ingredients (like Splenda or NutraSweet) and add it VERY slowly to avoid cramping and gas.  Not sure what brand is best?  Click here to see my recommendation.

Getting enough dietary fiber is very important, and not just to avoid constipation.  It helps maintain healthy weight and blood cholesterol levels, supports the hard work your liver does every day, and keeps your intestinal bacteria happy and healthy.  It’s not difficult to get dietary fiber, just add lots of fresh plant foods to your diet and you’ll see a huge difference in no time.

QUESTION: Do you struggle to get enough fiber in your diet?  Do you even think about how much fiber you’re getting?

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