Natural Ways to Heal

ATTENTION DEFICIT DISORDER

ADD and ADHD are essentially the same thing. Because at least half the people who have this disorder are not hyperactive, I prefer the term ADD.

I often tell people that I know more about ADD than I want to know. My son, Antony, was diagnosed with ADD when he was twelve years old. His room used to follow the second law of physics, meaning that things went from order to disorder. I used to ask him if he planned to have his room that messy. Moreover, his handwriting was a mess, and a half an hour of homework used to take him three hours to do with his mother’s yelling at him to sit down and get it done.

On the surface, Breanne, my oldest daughter, was the perfect child. She was always easy, always sweet, her room was always clean, and her homework always done. If I only had Breanne, I would have been a terrible child psychiatrist. I would have thought Breanne was so wonderful because I was such a good dad. If I saw your child acting up in the grocery store, I would have thought to myself, “Give me your child for a week and I will straighten him out and then teach you how to be a good parent.” Well, God knew I was like that, so God gave me Kaitlyn.

Hyperactive from before birth. We thought Kaitlyn was going to be a boy, because the lore is that the more active babies are inside their mother’s womb, the more likely they are to be boys. Well, she wasn’t. Trying to hold Kaitlyn when she was a year old was like trying to hold a live salmon.

I had a spiritual crisis because of this child. Many Catholic churches allow young children to sit with their parents at mass. It was no fun with Kaitlyn, because she was the worst behaved child at church, which was not only embarrassing, but it was bad for business. I treated half the children in the congregation and if my child was the worst one, people would lose confidence in me. So after a while I stopped going to church.

Have you ever seen children on little yellow leashes in the mall? After having Kaitlyn, I became a firm believer in little yellow leashes because she was always trying to get away. But my problem was that I wrote a column in the local newspaper where I lived, and whenever I went to the mall people recognized me and said things like “Hey, you are Dr. Amen, I loved your column.” I just could not deal with “Hey, you’re Dr. Amen, why is your child on a leash?” So what I used to do with Kaitlyn was put her in her stroller and tie her shoelaces together so she couldn’t get out. Now, I am not proud of that, but when you have a hyperactive child you do things just to survive.

When Katie was three years old, I went back to church but left her at home. I went to pray for a healing. I believe in healings. At the time I knew that 30 percent of three-year-olds look hyperactive, but only 5–10 percent of four-year-olds are hyperactive. So the first time you can really diagnose ADD with confidence is when the patient is four years old. I lit candles at church and even put an extra fifty dollars in the offering, trying to bribe God. I wrote to the pope and asked him to send a blessed picture that I could put by her bed. But he must have had an ADD secretary because no one wrote me back. At the age of four, I brought Kaitlyn to a colleague who diagnosed her with ADD.

The hallmark symptoms of ADD are short attention span, distractibility, disorganization, procrastination, and poor internal supervision. Some people are hyperactive like Kaitlyn, but many are not.

Short attention span is the key symptom of ADD, but it is not short attention span for everything. People with ADD have trouble with regular, routine everyday attention—the kind of attention that makes life work, such as getting your homework done, paying bills on time, doing your expense report at work, or listening to your spouse. For activities and events that are new, novel, highly stimulating, interesting, or frightening, people with ADD can pay attention just fine. It is as though they need stimulation in order to pay attention, which is why they ride motorcycles, go to scary movies, engage in high-risk activities, and tend to be conflict seeking in their relationships. Many people with ADD play this game I call “let’s have a problem.” If they are upset, they can focus and may even overfocus on the problem. This trait often fools people, even doctors, because if you can pay attention to things you love, but not most things, then people do not think you have ADD; they just think you are lazy.

Distractibility is another common symptom. Most of us can block out things we do not need to think about, but this is not the case for people with ADD. If someone drops a pencil three rows over, their attention immediately goes to the pencil. People with ADD also tend to feel everything. They hate tags and their clothes have to be just right or they get upset. They are often sensitive to touch and may need white noise at night to sleep; otherwise they hear everything in the house. Distractibility often affects a woman’s ability to have an orgasm. What does an orgasm require? Attention! You have to pay attention to the feeling long enough to make it happen. After properly treating ADD, many people’s sex lives get much better.

Many people with ADD are disorganized. Their rooms, desks, and book-bags are often a mess and they tend to be late. You can tell the ADD people at work because they are always ten minutes late and usually show up with a big cup of coffee in their hands. Many people with ADD self-medicate with stimulants, such as caffeine and nicotine.

Many people with ADD also have what I call poor internal supervision. They don’t think before they say things and they don’t think before they do things, which gets them into lots of hot water. Many people with ADD have trouble with long-term goals. The moment is what matters to them, not five moments from now or ten moments from now, but now. They wait till the last minute to get things done and have trouble saving for retirement. They also take what I call a crisis management approach to life. It seems as though their life goes from one crisis to the next.

For many people with ADD, the harder they try the worse it gets. On brain SPECT studies we see that the brain is usually normal at rest, but when the patient tries to concentrate there is decreased activity in the front part of the brain (see Images 6.1 and 6.2). Stimulant medications seem to help because they prevent this shutdown from occurring so people can concentrate. This is like putting your foot on the gas pedal and the car goes slower.

There are many myths and misconceptions about ADD. Here are just a few.

The first myth is that ADD is a fad or something new. Yet it has been described in the medical literature for well over a hundred years. It is true not as many people were diagnosed with ADD fifty years ago, but they existed and they were punished more in school or just labeled as bad or lazy kids.

The second myth is that everyone outgrows ADD by the time they hit puberty. About half the people who have it as children will have symptoms as adults, even older adults. I have treated many three-or four-generation families with ADD. In one of my favorite families I treated the six-year-old son, the mother, the grandfather, and the ninety-four-year-old great-grandmother. When the great-grandmother came in my office, I asked her why she was there. She said, “I want to finish the newspaper. I have never been able to finish the paper.” On treatment a month later she came back into my office with a big smile and told me she had read her first book.

ADD Scans

Image 6.1
ADD at rest

Image 6.2
ADD with concentration (note the deactivation)

The third myth is that ADD is only a minor problem. Yet 35 percent of these children left untreated never finish high school. According to one study 52 percent of untreated ADD teens and adults will abuse drugs or alcohol. And according to another study 43 percent of untreated aggressive hyperactive boys will be arrested for a felony by the time they are sixteen. Seventy-five percent of people with untreated ADD have interpersonal problems. Why? In my lectures I often ask the audience, “How many of you are married?” Most of the audience raise their hands. I continue, “Is it helpful for you to say everything you think in your marriage?” The audience laughs. “Of course not,” I continue. “Relationships require tact. They require forethought. But when you have low activity in the front part of your brain, as most people with ADD do, you often say the first thing that comes into your mind, which hurts other people’s feelings.”

I often say the brain is a sneaky organ. We all have weird, crazy, stupid thoughts that no one should ever hear. It is the front part of our brain that protects us from saying those stupid thoughts out loud. It acts as the brain’s brake. I was once at a conference with one of my friends who has ADD and a brain injury. Two obese women were sitting in front of us talking about their weight problems. One woman said to the other, “I don’t know why I am so fat. I eat like a bird.” My friend looked at me and said loud enough for everyone around us to hear, “Yeah, like a condor.” I looked at my friend in total embarrassment. Horrified, my friend put her hand over her mouth and said, “Oh my God, did that thought get out?” I nodded yes as the women moved away from us in disgust.

The last myth is that ADD is a disorder mostly of males. Some studies indicate that girls have ADD nearly as much as boys, but they are not diagnosed because, unlike Kaitlyn, most of them are not hyperactive. They frequently suffer with ADD symptoms and never get anywhere near their potential. They are passed off as lazy or not that smart.

Even though Breanne, my oldest daughter, was the perfect child, the truth is I never thought she was very smart. It embarrasses me to say that, but that was how I felt. I had to teach her simple things over and over and she did not learn her times tables until she was in fifth grade. I had her tested by a colleague in the third grade who basically told me the same thing, that she wasn’t that smart. She didn’t say it that way, but I could read between the lines. But the psychologist said Breanne would be okay because she worked so hard. In fact, in eighth grade Breanne won a presidential scholar award, not for academics but for effort. In tenth grade, however, things started to fall apart. She was in a college prep school and stayed up every night until one or two o’clock in the morning to get her homework done. Then one night, while studying biology, she came to me in tears and said she thought she could never be as smart as her friends. It broke my heart. The next day I pulled up her original scan, taken when she was eight years old. When I first started to do scans in 1991, I scanned everyone I knew. I had scanned my three kids, my mother, even myself. At the time I only had the experience of someone who had seen fifty scans. Now, seven years later, I had seen thousands of scans. With experienced eyes I was horrified with what I saw. Breanne had low overall activity, especially in the front part of her brain.

I came home that night and told Breanne what I saw and told her I wanted to get a new scan. Because of the injection with the procedure, she protested, “I don’t want a scan, Dad. All you think about are scans.” But I am a child psychiatrist. I know how to get my way with kids. I felt this was very important and so I asked her what it would take to get a scan. She told me she wanted a telephone line in her room. I started to think that maybe she was smarter than I thought. Her new SPECT study was virtually identical to the one seven years earlier. I cried when I saw it.

The next night on a low dose of medication I rescanned her, and her brain normalized. Breanne’s learning struggles had nothing to do with her intelligence. The low activity in her brain was limiting the access she had to her own brain. I put her on a low dose of medicine along with some supplements. A few days later she said that learning was much easier for her. She started bringing home A’s on her tests, which had never happened before. When she went to biology, she said she understood concepts for the first time. Usually a shy child in class, she started raising her hand and even participated in debates. At dinner one night she winked at me and said, “I kicked butt in a debate today.” This was not the same child I knew. Four months after her scan, she got straight A’s for the first time in her life. She repeated the feat all the way through high school and most of college. She has a completely different perception of herself—one that fits her reality of being smart, competent, and able to look forward to a bright future.

When you effectively treat someone with ADD you can change their whole lives. Then why are medications like Ritalin so controversial? Because although they work for some people with ADD, they can make other people much worse. Until I started doing scans I did not know why. What I found out from imaging was that ADD was not one thing, it was at least six different things, and giving everyone the same treatment helped some people but created disasters in others.

Here is a brief description of the six types and treatments.

Type 1: Classic ADD

Primary ADD symptoms plus hyperactivity, restlessness, and impulsivity. On SPECT scans we see decreased activity in the prefrontal cortex, especially with concentration. Usually diagnosed early and effectively treated with stimulant medications (e.g., Adderall, Concerta, Ritalin, Dexedrine, Strattera, or Provigil), fish oil, exercise, and a higher protein, lower simple carbohydrate diet. Supplement alternatives to medication include L-tyrosine, DL-phenylalanine, L-theanine, acetyl-L-carnitine, and grape seed extract (see Chapter 6).

Type 2: Inattentive ADD

Primary ADD symptoms plus low energy and motivation, spaciness, and internal preoccupation. On SPECT scans we see decreased activity in the prefrontal cortex and cerebellum, especially with concentration. Type 2 is diagnosed later in life, if at all. It is more common in girls. These are quiet kids and adults, often labeled lazy, unmotivated, and not that smart. It is also effectively treated with stimulant medications (e.g., Adderall, Concerta, Ritalin, Dexedrine, Strattera, or Provigil), fish oil, exercise, and a higher protein, lower simple carbohydrate diet. Supplement alternatives to medication include L-tyrosine, DL-phenylalanine, L-theanine, acetyl-L-carnitine, and grape seed extract (see Chapter 6).

Type 3: Overfocused ADD

Primary ADD symptoms plus cognitive inflexibility, trouble shifting attention, preoccupation with negative thoughts or behaviors, worrying, grudge holding, argumentative and oppositional behaviors, and a need for sameness. Often seen in families with alcoholism, addiction problems, or obsessive-compulsive tendencies. On SPECT scans we see decreased activity in the prefrontal cortex with concentration plus increased anterior cingulate activity. Stimulants, by themselves, usually make this type worse; people become more focused on the things that bother them. Effectively treated with the antidepressant Effexor, or a combination of a selective serotonin reuptake inhibitor (SSRI; e.g., Prozac) and a stimulant, fish oil, exercise, and a higher carbohydrate diet. Supplement alternatives to medication include a combination of a stimulating supplement, such as L-tyrosine with a serotonin-boosting supplement such as 5-hydroxytryptophan (5-HTP) and St. John’s wort (see Chapter 6).

Type 4: Temporal Lobe ADD

Primary ADD symptoms plus a short fuse, tendency to misinterpret comments, periods of anxiety, headaches or abdominal pain, history of head injury, family history of rages, dark thoughts, memory problems, and a struggle with reading. Often seen in families with learning or temper problems. On SPECT scans we see decreased activity in the prefrontal cortex with concentration and decreased temporal lobe activity. Stimulants, by themselves, usually make people with this type more irritable. Effectively treated with a combination of antiseizure medications (such as Neurontin) and stimulants, fish oil, exercise, and a higher protein diet. Supplement alternatives to medication include a combination of a stimulating supplement, such as L-tyrosine with gamma-aminobutyric acid (GABA) to help stabilize moods or gingko, phosphatidylserine, or huperzine to help with learning and memory (see Chapter 6).

Type 5: Limbic ADD

Primary ADD symptoms plus chronic mild sadness, negativity, low energy, low self-esteem, irritability, social isolation, poor appetite, and sleep patterns. On SPECT scans we see decreased activity in the prefrontal cortex at rest and with concentration and increased deep limbic activity. Stimulants, by themselves, usually cause problems with rebound or cause depressive symptoms. Effectively treated with the antidepressant Wellbutrin or the supplement S-adenosyl-methionine (SAMe) plus fish oil, exercise, and a balanced diet. Supplement alternatives to medication include SAMe, L-tyrosine, or DL-phenylalanine.

Type 6: Ring of Fire ADD

Primary ADD symptoms plus extreme moodiness, anger outbursts, oppositional, inflexibility, fast thoughts, excessive talking, and extreme sensitivity to sounds and lights. I named it Ring of Fire after the intense ring of overactivity that I saw in the brains of affected people. This type is usually made much worse with stimulants if used alone. I usually start with a supplement combination called Neurolink, which contains GABA, 5-HTP, and L-tyrosine. Sometimes a stimulant may also be needed. Medication alternatives include anticonvulsants (e.g., Neurontin) and an SSRI medication, the use of the novel antipsychotic medications (e.g., Risperdal or Zyprexa) plus fish oil, exercise, and a balanced diet.

         

Knowing your type is essential to getting the right help for yourself. If these descriptions are not clear enough, consider picking up my book Healing ADD or taking our ADD Type Test at www.amenclinics.com.

Common Treatments for All Types

There are many treatments common to all people with ADD. Here are the most important ones to start with today.

1. Take a 100 percent multiple vitamin every day. Studies have reported that they help people with learning and help prevent chronic illness. No matter what type of ADD you or your child has, take a 100 percent vitamin and mineral supplement a day. When I was in medical school the professor who taught our course in nutrition said that if people eat a balanced diet they do not need vitamin or mineral supplements. I have seen that balanced diets are a thing of the past for many of our “fast-food families.” In my experience, ADD families in particular have problems with planning and tend to eat out much more frequently than non-ADD families. Protect yourself and your child by taking a 100 percent vitamin and mineral supplement. In a 1988 study published in the British journal Lancet, ninety children between the ages of twelve and thirteen were divided into three groups. One group took no tablet, one group took a typical multiple vitamin and mineral tablet, and the last group took a tablet that looked and tasted just like the vitamin and mineral tablet yet contained no vitamins or minerals. The results of this well-controlled study was that the group who took the vitamin and mineral tablet had a significant increase in nonverbal intelligence, while the other two groups showed no difference at all. The subclinical vitamin and mineral deficiency may have been contributing to these students performing below their abilities.

2. Omega-3 fatty acids have been found to be helpful in children with ADD. There are three double-blind studies suggesting their value, plus people with ADD have been found to have low levels of omega-3 fatty acids in their blood. Omega-3 fatty acids have two major components: epicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). EPA tends to be stimulating while DHA tends to be sedating (personal communication with Joe Hibbeln at the National Institutes of Health in 2007). For Types 1 and 2 I recommend the EPA component of fish oil (NeuroEPA from Amen Clinics) and for the other types a combination of EPA and DHA (NeurOmega). For adults I recommend taking 2,000–4,000 milligrams a day and 1,000–2,000 milligrams for children. An easy form for children to take is Coromega.

3. Eliminate caffeine and nicotine. They both interfere with sleep and decrease the effectiveness of other treatments.

4. Intense aerobic exercise daily for thirty to forty-five minutes. Kids should engage in a safe exercise like long, fast walks (no brain injuries, please).

5. Turn off the television and video games, or limit them to no more than thirty minutes a day. This may be hard for kids and teens, but it can make a huge difference.

6. Food is a drug. Most people with ADD do best with a higher protein, lower simple carbohydrate diet. In a 2008 study from Holland, researchers found that putting children on a restricted elimination diet reduced ADD symptoms by more than 50 percent in 73 percent of children, which is basically the same effectiveness of stimulant medication without any of the side effects. Elimination diets are not easy to do. Basically, during the study the children could only eat rice, turkey, lamb, vegetables, fruits, margarine, vegetable oil, tea, pear juice, and water. But the results were stunning. Elimination diets may be a place to start; by gradually adding back other foods you will be able to see what items may be causing the abnormal behaviors. Working with a nutritionist may make a big difference. In this study the researchers also found that the children’s moods and oppositional behaviors were also improved. People with Type 3 do better with more carbohydrates in their diet. Types 5 and 6 seem to do better with more balanced diets, like the Zone Diet described by Barry Sears.

7. In dealing with kids, employees, and even spouses with ADD, no yelling! Many people with ADD seek conflict or excitement as a means of stimulation. They can be masters at making other people mad or angry. Do not lose your temper with them. If they get you to explode, their unconscious, low energy prefrontal cortex lights up and likes it. Never let your anger be their medication. They can get addicted to it.

Natural Supplement Strategies for Each Type

In this section I will reexamine each ADD type and provide more details about the supplements that I have seen to have clinical benefit. I’ll give you the rationale and dosage protocols that I suggest to my patients. If you decide to use these supplements instead of medication, as many people do, make sure you keep tabs on their effectiveness. I only want my patients to take something that is clearly beneficial to them. I also want them to take medication if the supplements are not effective. Many parents say that they want to try the natural supplements before they try medication. I’m not opposed to that, but I worry that if the supplements are not fully effective that they will not pursue more effective treatments, as people with ADD are masterful at procrastination. Follow through to find what works for yourself or your child. Be open to new ideas and persist until you get the best brain and life functioning. Of the different options, try them in the order I list and initially try them one at a time unless I note differently. Please be sure to discuss these options with your health care professionals.

TYPE 1: CLASSIC ADD AND TYPE 2: INATTENTIVE ADD

Supplement alternatives for Type 1 and 2 include L-tyrosine, DL-phenylalanine, acetyl-L-carnitine, L-theanine, or grape seed extract. These types seem to be due to deficiencies of the neurotransmitter dopamine.

L-TYROSINE

A search of the medical literature on L-tyrosine found eighteen studies that apply to mental health and learning involving approximately 503 patients. Of the eighteen studies, eleven are positive and seven are negative. In my experience, L-tyrosine can have a mild positive effect on Types 1 and 2 ADD.

I frequently prescribe the amino acid L-tyrosine in doses of 500 milligrams to 1,500 milligrams two to three times a day for adults and 100 milligrams to 500 milligrams two to three times a day for children under age ten. L-tyrosine is the amino acid building block for dopamine, the neurotransmitter implicated in ADD. It is reported to increase the level of phenylethylamine, a mild stimulant that is found in high concentrations in chocolate. Many of my patients have reported that it is helpful for them. It is softer in its effect, but nonetheless they notice a positive effect. Because of absorption patterns, I recommend that they take it on an empty stomach (a half hour before meals or an hour after meals). I have not seen any side effects with L-tyrosine, except for mild weight loss. If it is given by itself to Type 3 ADD patients, it tends to increase the intensity of overfocused symptoms. Patients with a history of mania should exercise caution with the use of L-tyrosine because the energizing properties of this compound may trigger a manic episode.

L-tyrosine is also the amino acid building block for epinephrine and norepinephrine. L-tyrosine has been reported to help boost energy levels, mood, focus, and metabolism. L-tyrosine may increase motivation and improve concentration. Research suggests that L-tyrosine acts to help the body adapt and cope with stress. Taken ahead of time, L-tyrosine allows some people to avoid typical bodily reactions and feelings from stressful situations like surgery, emotional upset, and sleep deprivation. L-tyrosine appears to be a successful addition to conventional treatment for cocaine and nicotine withdrawal. L-tyrosine levels are also low in some depressed patients. A number of studies conducted in the 1970s showed encouraging results regarding the use of L-tyrosine to ease symptoms of depression, especially when used together with the supplement 5-HTP.

Phil, age sixteen, had been treated for Type 1 ADD for several years. He was taking Ritalin, which would work for a while and then seem to wear off. The up-and-down effectiveness of the medication frustrated him. He tried Adderall, but it seemed to have the same effect. I stopped the stimulant medications, put him on 1,000 milligrams of L-tyrosine three times a day, was firm about dietary guidelines, and encouraged Phil to walk fast for an hour five times a week. Within a week, he said he felt better. He has maintained the regimen for four years now.

DL-PHENYLALANINE

A search of the medical literature on DL-phenylalanine found four studies that apply to mental health and learning involving approximately ninety-three patients. Of the four studies, all are positive. In my experience, DL-phenylalanine can have a mild positive effect.

DL-phenylalanine is an essential amino acid, which means that it is essential to human health but is not manufactured in the body, so it must be obtained from food or supplements. The body converts DL-phenylalanine into L-tyrosine, another amino acid essential for making proteins, certain brain chemicals, and thyroid hormones. Symptoms of DL-phenylalanine deficiency include confusion, lack of energy and decreased alertness, memory, and appetite. A number of studies show norepinephrine and epinephrine (adrenaline) to be low in patients with depression. The antidepressants imipramine and desipramine work in part by increasing norepinephrine in the brain. Theoretically, when more precursor is available, more neurotransmitters will be made. Therefore it makes sense that by boosting DL-phenylalanine we can increase norepinephrine and have a positive impact on concentration and mood. In fact, in a number of studies DL-phenylalanine has been found to be helpful for depression, energy, and pain control. I have used it for twenty years as an antidepressant in children, teens, and adults. It is milder in its effect than prescribed antidepressants, but it also causes significantly less side effects. People who have phenylketonuria, commonly known as PKU, should not take DL-phenylalanine, because they do not have the enzyme that metabolizes it. The recommended dose is 400 milligrams three times a day on an empty stomach for adults and 200 milligrams three times daily for children.

ACETYL-L-CARNITINE

A search of the medical literature on acetyl-L-carnitine (ALC) found twenty-six studies that apply to mental health and learning involving approximately twenty-one hundred patients. Of the twenty-six studies, twenty-three are positive and three are negative. In my experience, ALC can have a mild positive effect.

ALC is a nutrient that has been reported to improve mental focus, enhance energy, and slow aging. Research has shown that ALC increases levels of neurotransmitters needed for memory, focus and learning, and repairs the damage done to brain cells caused by stress and poor nutrition. About 95 percent of energy production in your cells occurs in the mitochondria. Many diseases of aging are increasingly being referred to as “mitochondrial disorders.” ALC has been shown to help increase energy production in the mitochondria.

From Italy comes a fascinating study about the use of ALC for ADHD and Fragile X syndrome. It is a treatment we should consider for ADHD children and adults. Fragile X syndrome is the most common hereditary form of mental retardation. Many children with Fragile X syndrome also suffer from ADHD, which complicates social relationships at home and at school. Although stimulant medication such as Ritalin is often effective, it also causes side effects such as increased irritability, decreased verbalization, and social withdrawal. A previous study showed that ALC significantly reduced hyperactive behavior in Fragile X syndrome boys with ADHD who were treated with it for one year without causing adverse side effects. The same authors have now conducted a randomized, double-blind, placebo-controlled multicenter study to determine the effectiveness of ALC in a larger group. Led by M. Giulia Torrioli and Giovanni Neri of the Università Cattolica in Rome, the study involved fifty-one boys between six and twelve years old with Fragile X syndrome and ADHD who were treated in one of eight centers in Italy, France, and Spain. Each patient followed the treatment for twelve months, which involved 500 milligrams of ALC or a placebo given twice daily. Patients were evaluated by a team of child neuropsychiatrists and psychologists at the start of the study, after one month, six months, and twelve months. The effects of the drug and placebo were evaluated using a set of neuropsychological tests to assess behavior. Those treated with ALC demonstrated reduced hyperactive behavior and increased attention. No side effects were exhibited, confirming that ALC is a safe alternative to stimulants. The patients treated with the placebo also showed reduced hyperactive behavior, although not nearly to the extent as the ALC-treated patients. The patients treated with ALC also had significantly improved social ability compared with the placebo-treated group. The authors proposed that ALC be recommended as a treatment of ADHD in Fragile X syndrome children, since it effectively reduces hyperactive behavior and improves social abilities without adverse side effects. They also suggest that these results may be applicable to children with autism, who also do not easily tolerate stimulants.

Some people report feeling an increase in mental energy and focus within twenty minutes, which is why you should not take it too late in the day, as it may give you insomnia. Even though ALC is not a stimulant, it seems to naturally increase energy in the brain. Over thirty studies show that ALC slows or prevents age-related decline in mental function. In one study, 1.5 grams a day of ALC given to 236 older adults for forty-five days significantly increased the effectiveness of performance on all the measures of cognitive functioning, memory performance, and constructional thinking. Twenty adults given 1.5 grams of ALC experienced reversal of many of the signs of brain aging. Alcoholics with cognitive impairment have also benefited from ALC. ALC is potentially valuable in helping depression. One hundred sixty patients who had suffered from a stroke a year or more ago were given 1.5 grams of ALC a day for eight weeks. This led to increased speed of recovery, as well as improved mood and attention span. A total of over 600 patients with Alzheimer’s disease have been studied in over twenty years of research, demonstrating that ALC benefits patients with dementia.

Because of lack of long-term safety studies, ALC is not advised for pregnant women or nursing mothers. Mild gastrointestinal symptoms may occur in those taking ALC, including nausea, vomiting, abdominal cramps, and diarrhea. Increased agitation has been reported in some with Alzheimer’s disease when taking oral ALC. In those with seizure disorders, an increase in seizure frequency has been reported in some taking ALC.

You should consider ALC if you suffer with tiredness, mental fatigue, memory loss, or attentional problems. The typical dose is 500–1,500 milligrams a day.

L-THEANINE

A search of the medical literature on L-theanine found six studies that apply to mental health and learning involving approximately eighty-five patients. Of the six studies, all showed some positive effect. In my experience, L-theanine can have a mild positive effect.

L-theanine is an amino acid mainly found naturally in the green tea plant. L-theanine is the predominant amino acid in green tea and makes up 50 percent of the total free amino acids in the plant. L-theanine is considered the main component responsible for the taste of green tea. It is marketed in Japan as a nutritional supplement for mood modulation. L-theanine may also have activity in modulating the metabolism of cancer chemotherapeutic agents and ameliorating their side effects.

L-theanine has been shown to penetrate the brain and produce significant increases in the neurotransmitters serotonin and/or dopamine concentrations. These findings led to recent studies investigating the possibility that L-theanine might enhance learning ability, induce relaxation, and relieve emotional stress. Memory and learning ability were said to be improved in young male Wistar rats given 180 milligrams of L-theanine daily for four months. Human performance was assessed using a test for learning ability and passive and active avoidance tests for memory. The mental effects of L-theanine were tested in a small group of volunteers divided into “high-anxiety” and “low-anxiety” groups. The volunteers were females ages 18–22. Their level of anxiety was assessed by a manifest anxiety scale. Subjects received water, 50 milligrams of L-theanine, or 200 milligrams of L-theanine solution once a week. Brain waves were measured 60 minutes after administration. The 200-milligram dose (dissolved in 100 milliliters of water) resulted in significantly greater production of alpha waves than was observed in subjects receiving water. The effect was dose-dependent. The researchers regarded the significantly increased production of alpha-brain wave activity as an index of increased relaxation.

Pregnant women and nursing mothers should avoid L-theanine supplements. Use of L-theanine supplements concomitantly with cancer chemotherapeutic agents must be done under medical supervision. There are no known adverse reactions.

L-theanine supplements are available for the promotion of relaxation and modulation of mood. Doses used are between 50 and 200 milligrams, as necessary. L-theanine is available in some green tea preparations. The amino acid constitutes between 1 percent and 2 percent of the dry weight of green tea leaves.

GRAPE SEED /PINE BARK EXTRACT (PYCNOGENOL)

A search of the medical literature on Pycnogenol found five studies that apply to ADD involving more than a hundred patients. Of the five studies, four showed some positive effect. In my experience Pycnogenol can have a mild positive effect.

Grape seed or pine bark extract has also shown some mild benefit for Type 1 and Type 2 ADD. Grape seed or pine bark extract are proanthocyanidin compounds. These compounds have been found to increase blood flow and they act as superantioxidants, twenty to fifty times as powerful as vitamin E. There are several published studies with grape seed or pine bark extract in ADD and a number of published case reports.

Here is an example from Slovakia. Sixty-one children were supplemented with 1 milligram per kilogram per day of Pycnogenol or placebo over a period of four weeks in a randomized, placebo-controlled, double-blind study. Patients were examined at start of trial, one month after treatment, and 1 month after end of treatment period by standard questionnaires. Results show that one-month Pycnogenol administration caused a significant reduction of hyperactivity, improved attention and visual-motoric coordination and concentration of children with ADD. In the placebo group no positive effects were found. One month after termination of Pycnogenol administration a relapse of symptoms was noted. The authors concluded that “the results point to an option to use Pycnogenol as a natural supplement to relieve ADHD symptoms of children.”

There is a body of medical literature that reports these compounds are very helpful for people with varicose veins. If you have ADD and varicose veins, then grape seed or pine bark extract may be for you.

Crystal, age forty-eight, came to the clinic for symptoms of ADD. Her whole life she had been restless, inattentive, easily distracted, terribly disorganized, and impulsive. After her third child she also developed terrible varicose veins, which I had noticed in the initial interview. When we talked about treatment options for her classic Type 1 ADD she said that she wanted to try the grape seed extract. Then she would see about other options. After three weeks she noticed that she felt better, had more energy, and her legs looked and felt better. Eventually we added L-tyrosine to give her more help with focus, but the regimen has worked well for her over the past several years.

TYPE 3: OVERFOCUSED ADD

This type of ADD seems likely due to a relative deficiency of both serotonin and dopamine. In this type I use something to enhance serotonin such as St. John’s Wort or 5-HTP plus something to enhance dopamine such as L-Tyrosine.

ST. JOHN’S WORT

A search of the medical literature on St. John’s wort found thirty-two studies that apply to mental health and learning involving approximately one thousand patients. Of the thirty-two studies, thirty were positive and two were negative. In my experience, St. John’s wort can have a significantly positive effect on mild to moderate depression and overfocused ADD when combined with L-tyrosine.

A high number of studies support the usage of St. John’s wort as an effective treatment for minor to moderate cases of major depression. St. John’s wort has also been shown to be better tolerated by individuals than prescription medication, with less side effects. In addition, randomized, double-blind studies have shown St. John’s wort to be equally as effective as antidepressant prescription medications (e.g., citalopram, paroxetine, fluoxetine, sertraline, and imipramine).

I have seen that a combination of St. John’s wort and L-tyrosine is often very helpful. St. John’s wort comes from the flowers of the Saint-John’s-wort plant (wort is Old English for “plant”). It got its name from the fact that it blooms around June 24, the feast day of St. John the Baptist, and the red ring around the flowers when crushed looks like blood, the blood of the beheaded John the Baptist. St. John’s wort seems to increase serotonin availability in the brain. The starting dosage of St. John’s wort is 300 milligrams a day for children, 300 milligrams twice a day for teens, and 600 milligrams in the morning and 300 milligrams at night for adults. Sometimes I’ll go as high as 1,800 milligrams in adults. The bottle should say that it contains 0.3 percent hypericin, which is believed to be the active ingredient of St. John’s wort. I have done a number of before-and-after SPECT studies with St. John’s wort. It clearly decreases cingulate gyrus hyperactivity for many patients. It also helps with moodiness and trouble shifting attention. Unfortunately, I have also seen it decrease prefrontal cortex activity. One of the women in the study said, “I’m happier, but I’m dingier.” When cingulate symptoms are present with ADD symptoms, it’s important to use St. John’s wort with a stimulating substance like L-tyrosine or a stimulant such as Adderall.

It has been reported that St. John’s wort increases sun sensitivity (you could get sunburned more easily) and may decrease the effectiveness of birth control pills and antiviral medications. Also, don’t use it if temporal lobe symptoms are present, without first stabilizing the temporal lobes.

Elaine, age sixteen, had always been a worrier. She also had problems with anger at home. If things did not go her way she would explode at her parents or at her younger sister. As a student she was a perfectionist, which caused her to spend excessive time on assignments. Her mother, a school principal, brought her to my clinic after she heard me lecture. She told me that she was sure Elaine had Type 3 ADD, causing her to overfocus. Her SPECT study showed marked increased activity in her anterior cingulate gyrus. She also had mild decreased activity in her prefrontal cortex. I placed her on St. John’s wort, 600 milligrams in the morning and 300 milligrams at night. I also had her take 500 milligrams of L-tyrosine two to three times a day. Within a month Elaine was much better. She was more relaxed, less reactive, and did much better in her classes. She said that studying was easy because she no longer felt the need to have everything just so. She still wanted to excel, but didn’t have to copy pages over three and four times until things were perfect.

5-HTP

A search of the medical literature on 5-HTP found twenty-five studies that apply to mental health and learning involving approximately one thousand patients. Of the twenty-five studies, twenty-one were positive and four were negative. In my experience, 5-HTP can have a significantly positive effect on anxiety, worry and sleep, and overfocused ADD when combined with L-tyrosine.

5-HTP is a step closer in the serotonin production pathway. It is also more widely available than L-tryptophan and it is more easily taken up in the brain. Seventy percent is taken up into the brain, as opposed to only 3 percent of L-tryptophan. 5-HTP is about five to ten times more powerful than L-tryptophan. A number of double-blind studies have shown that 5-HTP is as effective as antidepressant medication. It boosts serotonin levels in the brain and helps to calm cingulate gyrus hyperactivity (greasing the cingulate, if you will, to help with shifting of attention). The dose of 5-HTP for adults is 50–300 milligrams a day. Children should start at half dose. Take 5-HTP and L-tryptophan on an empty stomach. The most common side effect of 5-HTP is an upset stomach. It is usually very mild. Start slowly and work your way up slowly.

TYPE 4: TEMPORAL LOBE ADD

Temporal lobe ADD is a combination of temporal lobe dysfunction and poor prefrontal cortex activity. Strategies geared toward temporal lobe stabilization and enhancement have proven valuable for this ADD type. From a medication standpoint, I have seen antiseizure (also called anticonvulsant) medications be the most helpful. One of the mechanisms by these medications works by enhancing the amino acid GABA.

GABA

A search of the medical literature on GABA found only one study that applies to mental health and learning. GABA is a major neurotransmitter widely distributed throughout the brain. Because too much excitation in the brain can lead to irritability, restlessness, insomnia, seizures, and movement disorders, it must be balanced with inhibition. GABA—the most important inhibitory neurotransmitter in the brain—provides this inhibition, acting like a brake during times of runaway activity. Medications for anxiety, such as Valium and anticonvulsants, stimulate GABA receptors and induce relaxation. Either low GABA levels or decreased GABA function in the brain is associated with several psychiatric and neurological disorders, including anxiety, depression, insomnia, and epilepsy. Studies indicate GABA can improve relaxation and enhance sleep. GABA is available as dietary supplements in the United States.

The mechanisms of most antiseizure drugs involve direct or indirect GABA enhancement. The drugs act in a variety of ways by increasing GABA availability. The ketogenic diet, employed in particular for treatment of childhood epilepsy, is theorized to work via a GABA mechanism. Ketosis increases brain metabolism of acetate, which is converted to glutamine by glial cells. Glutamine is then taken up by GABA neurons and converted to GABA. Electroencephalogram tracings in healthy human subjects on a ketogenic diet yielded patterns consistent with increased GABA activity. Research indicates oral GABA supplementation may be beneficial for epilepsy. Several animal and clinical studies have examined the effect of a combination of GABA and phosphatidylserine (PS) in the treatment of various types of seizure disorders. A pilot study of forty-two subjects with drug-resistant epilepsy (ten with absence seizures [periods of spaciness]) found a combination of increasing doses of GABA (1,500–2,500 milligrams daily) and PS (300–500 milligrams daily)—in separate capsules—resulted in a significant, dose-dependent decrease in absence seizures, but not in simple or complex partial seizures.

I have seen GABA have a calming effect on people who struggle with temper, irritability, and anxiety (all of which may be temporal lobe symptoms). The doses of GABA range from 250 milligrams–750 milligrams twice a day for adults, half that for children.

Many people with temporal lobe ADD suffer from memory problems. I have found a number of natural substances helpful to enhance memory, including gingko biloba, PS, and huperzine A. These are discussed in chapter 8.

TYPE 5: LIMBIC ADD

Limbic ADD has many symptoms of mild depression, including negativity, sadness, feelings of hopelessness, and an overabundance of automatic negative thoughts. Frequently I have seen stimulants make people who have this type of ADD more negative and moody. The supplements that seem to help this type of ADD best are SAMe, DL-phenylalanine, or L-tyrosine. DL-phenylalanine and L-tyrosine were described earlier.

SAME

A search of the medical literature on SAMe found forty-nine studies that apply to mental health, learning, and pain involving more than a thousand patients. Of the forty-nine studies, thirty-eight were positive and eleven were negative. In my experience, SAMe can have a significantly positive effect on mood, pain, energy, and focus.

SAMe is involved with the production of many important brain compounds, including neurotransmitters. It donates “methyl” groups to these compounds so that they can function properly. Normally, the brain manufactures all the SAMe it needs from the amino acid methionine. In depression, however, this synthesis has been found to be impaired. Supplementing the diet with SAMe has been found to increase the neurotransmitters involved with depression and improve cell membrane fluidity. SAMe is one of the best natural antidepressants; a number of recent studies have shown that it is as effective as antidepressant medication. SAMe has also been found helpful for people who suffer from fibromyalgia, a chronic muscle pain disorder. Fibromyalgia and ADD run commonly together. I think the chronic stress associated with ADD is in part responsible for the muscle pain. People who have bipolar disorder or manic-depressive illness or Type 6 (Ring of Fire) ADD should not take SAMe. There have been a number of reported cases of SAMe causing manic or hypomanic episodes (excessively up or happy moods, extreme impulsivity in sexuality or spending money, pressured speech, or decreased need for sleep). I think these reports highlight that SAMe is an effective antidepressant, as all of the prescription antidepressants have that capability as well.

In one study from UCLA, Walid Shekim and colleagues used oral SAMe in a sample of well-diagnosed adults with ADHD, in a four-week open trial to establish SAMe effectiveness and safety and in a nine-week, double-blind, placebo-controlled crossover trial. Preliminary data from the open trial reveal that 75 percent (six out of eight male) patients improve on it. The two who did not improve had not improved on the methylphenidate trial. Improvement ranged from moderate to marked, with minimal and transient side effects that did not interfere with functioning.

The dosage of SAMe is between 200 milligrams and 400 milligrams two to four times a day, half that for children. Nature’s Made is a good brand and is sold at Costco, lowering the cost significantly.

TYPE 6: RING OF FIRE ADD

Type 6 ADD is often associated with intense ADD symptoms, such as intense hyperactivity and distractibility, severe impulsiveness, hypersensitivity to the environment, pressured speech, and cyclic mood changes. I think that this type of ADD may be related to bipolar disorder. Stimulants, by themselves, tend to make it worse. At the Amen Clinics we use the supplement Neurolink and high-quality fish oil. Neurolink is a combination of GABA, 5-HTP, inositol, and L-tyrosine. GABA is an inhibitory neurotransmitter and may help to calm overactive areas, 5-HTP and inositol act to increase serotonin availability and may help increase mood and flexibility, while L-tyrosine is the amino acid building block for dopamine and may help with focus and motivation. I usually start with two capsules twice a day for three weeks, then increase to three capsules twice a day for three weeks, then if needed go to four capsules twice a day. Patience is needed as it often takes several weeks for it to be effective. In addition to Neurolink, we also use high-quality fish oil, which has been found to be helpful in mood disorders and to calm hyperactive brain function. We recommend 2,000–4,000 milligrams a day of NeurOmega from the Amen Clinics or Coromega. For more severe clinical presentations, I recommend fish oil plus an anticonvulsant medication or atypical antipsychotic to start and often an antidepressant after mood stabilization is obtained.

Cody came to see me from Georgia. He had all of the symptoms of ADD, but when he was placed on Ritalin he became more obsessive, couldn’t sleep, and bit his fingernails until they bled. His scan did not show the typical ADD pattern but showed that he had too much activity in his brain. He needed something to calm his brain down, not stimulate it. On Neurolink, a natural supplement we produce that contains GABA, 5-HTP, and L-tyrosine, he did much better.

Through the years I have treated many pilots with ADD who cannot take medicine and keep their Federal Aviation Administration licenses, which seems a bit backward to me. I want my pilot to be able to concentrate and really don’t want him to be distracted or conflict seeking when he is flying the plane. But because of the regulations pilots need natural treatments in order to keep their jobs. Many people, although not everyone, can find success with natural treatments for ADD.