CHAPTER 20

Supplement Strategies for ADD Types

Through the years, many people have asked me about natural treatments for ADD. At least once a month a parent tells me about an amazing new treatment for ADD. Vitamins, herbs, fish oil, amino acids, grapeseed extract, and magnets to name a few. With three ADD children of my own, I’ve kept an open mind. I want to know about everything that works to help this disorder. Through the years, I have tracked each of these treatments, kept up on what little scientific literature exists, and constantly stay on the lookout to see what works. Wading through the claims, parental excitement, and failures is challenging. The good news, however, is that many of these treatments are helpful, especially if you target the interventions to specific ADD types.

A word of caution: Ignoring ADD type can cause some of these interventions to backfire and make things worse. Just because something is natural does not mean it’s innocuous. Here’s an example:

Seven-year-old Justin was brought to see me by his mother. He had symptoms of ADD (short attention span, restlessness, and impulse-control problems) along with temper problems. A month before I met Justin, his mother read a magazine article on St. John’s Wort. It said that it helped with mood and temper problems. She gave it to her son. Within a week Justin’s behavior was much worse. He was more hyperactive, angrier, and he started to have dreams of decomposing bodies. When she stopped the St. John’s Wort, his symptoms lessened. During Justin’s evaluation at my clinic, I did a SPECT scan. It showed decreased activity in his left temporal lobe. I have often seen that serotonergic interventions, such as selective serotonin reuptake inhibitors or St. John’s Wort, make temporal problems worse. It was clear to me that Justin needed something to help his temporal lobes. He had a very positive response to the anticonvulsant Depakote and Adderall.

Always check with your doctor before adding supplements to medication.

Some supplements will interact with medication, so caution is needed.

In this chapter I will go through each ADD type and tell you what supplements 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 consider 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. Follow through to find what works for you or your child. Be open to new ideas, and persist until you get the best brain and life functioning.

NO MATTER WHAT TYPE—100 PERCENT MULTIVITAMIN AND MINERAL SUPPLEMENT

I recommend a daily 100 percent multiple vitamin and mineral supplement for all types. 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 vitamin and mineral supplement that provides 100 percent of your daily allowances. In a study published in the British medical journal The 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 multivitamin 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 result 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.

OMEGA-3 FATTY ACIDS

Omega-3 fatty acids have been found to be helpful in children with ADD in a few studies, 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: EPA and DHA. EPA tends to be stimulating while DHA tends to be sedating. For Types 1 and 2, I recommend a higher EPA component of fish oil, and for the other types a combination of EPA and DHA. For adults, I recommend they take 2,000 to 4,000 milligrams a day; children should take 1,000 to 2,000 milligrams per day.

Here is a summary of several recent studies: In a study from Sri Lanka, one hundred children (ages six to twelve) who were resistant to treatment with Ritalin and behavior therapy for more than six months were given a combination of omega-3/6 fatty acids or a placebo. Outcome was measured at three and six months after treatment using a self-assessment checklist completed by the parents. Significant improvements were found in the treatment group compared with the placebo group in the following measures: restlessness, aggressiveness, completing work, and academic performance. Statistically significant improvement with inattention, impulsiveness, and cooperation with parents and teachers was not found at three months of treatment, but was evident at six months of treatment. This means you have to be patient and give the omega-3 fatty acids time to work.

In a study from Sweden, ninety-two ADHD children (ages seven to twelve) were given 500 milligrams of EPA omega-3s or a placebo for fifteen weeks. The EPA group improved their attention scores and had less oppositional behavior. The children who responded best had lower EPA levels to start.

In a study from the UK, researchers tested the level of omega-3 fatty acids in seventy-two children, twenty-nine with ADHD and forty-three without. Callous-unemotional (CU) traits were found to be significantly higher in the ADHD children with lower EPA levels. EPA levels were lower in the ADHD group. The findings report lower omega-3 levels in children with ADHD who had antisocial traits.

In an analysis of ten studies, researchers summarized ten trials involving 699 children. Omega-3 fatty acid supplementation demonstrated a small but significant effect in improving ADHD symptoms. EPA dose within supplements was significantly correlated with supplement efficacy. They concluded that omega-3 fatty acid supplementation, particularly with higher doses of EPA, was modestly effective in the treatment of ADHD.

TYPE 1 (CLASSIC) ADD AND TYPE 2 (INATTENTIVE) ADD

There are a number of stimulating herbs and supplements that my patients have found helpful for Classic and Inattentive ADD, including rhodiola, ginseng, ashwagandha, green tea, grapeseed extract, acetyl-L-carnitine, and L-tyrosine. We did a study with rhodiola and found it boosted blood flow to the brain.

As mentioned, these types seem to be due to deficiencies of the neurotransmitter dopamine. I frequently prescribe the amino acid L-tyrosine in doses of 500 to 1500 milligrams two to three times a day for adults and 100 to 500 milligrams two to three times a day for children under 10. L-tyrosine is the amino acid building block for dopamine. It is reported to increase the level of phenylethylamine (PEA), a mild stimulant that is found in higher 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. L-tyrosine does not work well by itself in treating Type 3 (Overfocused) ADD because it tends to increase the intensity of overfocused symptoms. Symptoms of tyrosine deficiency—which leads to low dopamine levels—include hypothyroidism, low blood pressure, low body temperature (cold hands and feet), and restless leg syndrome.

Phil 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.

Grapeseed or pine bark extract has also shown some mild benefit for Type 1 and Type 2 ADD. Grapeseed and pine bark extract are proanthocyanidin compounds. These compounds have been found to increase blood flow and act as superantioxidants, twenty to fifty times as powerful as vitamin E. There are no published studies on the use of grapeseed or pine bark extract for treating ADD, but there are a number of published case reports. (There is a body of medical literature that says these compounds are very helpful for people with varicose veins. If you have ADD and varicose veins, then grapeseed 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 Type 1 (Classic) ADD, she said that she wanted to try the grapeseed extract, then she would see about other options. After three weeks she noticed that she felt she 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. 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 St. John’s Wort plant (wort is Old English for plant). It got its name either from the fact that it blooms around June 24, the feast day of St. John the Baptist, or the red ring round the flowers that, when crushed, looks like blood—the blood of the beheaded John the Baptist. St. John’s Wort seems to be best at increasing 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 a total of 1800 milligrams a day 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, and I have no doubt that it decreases anterior 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 am happier, but I’m dingier.” When anterior 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 need to be careful in the sun). 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 Overfocused ADD. Elaine’s 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 600 milligrams of St. John’s Wort 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.

L-tryptophan (the amino acid building block for serotonin) and 5-HTP (also a serotonin building block) are other ways of increasing cerebral serotonin. L-tryptophan was taken off the market a number of years ago because one contaminated batch, from one manufacturer, caused a rare blood disease and a number of deaths. The L-tryptophan actually had nothing to do with the deaths. L-tryptophan is a naturally occurring amino acid found in milk, meat, and eggs. I have found it helps patients improve sleep, decrease aggressiveness, and improve mood control. In addition, it does not have side effects—a real advantage over the antidepressants. L-tryptophan was recently reapproved by the Food and Drug Administration and is now available by prescription. One of the problems with dietary L-tryptophan is that a significant portion of it does not enter the brain. It is used to make proteins and vitamin B3. This necessitates taking large amounts of tryptophan. I recommend L-tryptophan in doses of 1,000 to 3,000 milligrams taken at bedtime.

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 three 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 in treating depression. 5-HTP boosts serotonin levels in the brain and helps to calm anterior cingulate gyrus hyperactivity (“greasing” the anterior cingulate, if you will, to help with shifting of attention). The dose of 5-HTP for adults is 50 to 300 milligrams a day. Children should start at half dose. Take 5-HTP and L-tryptophan on an empty stomach for better absorption. The most common side effect of 5-HTP is an upset stomach. It is usually very mild, but it’s best to start with a low dose and work your way up slowly.

There have also been some recent studies with inositol, a vitamin from the B family, which is available at health food stores. In doses of 12 to 20 grams a day, it has been shown to decrease moodiness, depression, and overfocus issues.

Do not take St. John’s Wort, L-tryptophan, or 5-HTP with prescribed antidepressants, without the knowledge and close supervision of your physician.

SEROTONIN PATHWAY

Tryptophan

5-HTP

Serotonin

N-acetylserotonin

Melatonin

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. In my experience, antiseizure (also called anticonvulsant) medications seem to be the most helpful. We suspect that these medications that work for Type 4 enhance the availability of the amino acid gamma-aminobutyric acid (GABA), an essential neurotransmitter in the brain. Formed in the body from glutamic acid, GABA calms neuronal activity and inhibits nerve cells from overfiring or firing erratically. GABA can be taken as a supplement. It acts like an anticonvulsant and also as an antianxiety agent. In the herbal literature, it is reported to work in much the same way as tranquilizers, but without fear of addiction. I have seen it have a nice calming effect on people who struggle with temper, irritability, and anxiety (all which may be temporal lobe symptoms). The doses of GABA range from 100 to 500 milligrams a day for adults, half that for children. Magnesium can also be helpful to stabilize nerve cell firing, and has been used to help calm anxiety and irritability. Eighty percent of the population has been found to be low in magnesium. I often start patients taking 200 to 400 milligrams of magnesium citrate or magnesium taurate twice a day.

Many people with temporal lobe problems suffer from memory problems. I have found a number of natural substances helpful to enhance memory, including: gingko and vinpocetine for blood flow; Huperzine A and acetyl-L-carnitine to enhance the neurotransmitter acetylcholine; N-acetylcysteine and alpha lipoic acid, both potent antioxidants; and phosphatidylserine to help nerve cell membranes and lower stress hormones.

TYPE 5 (LIMBIC) ADD

Limbic ADD has many symptoms of mild depression, including negativity, sadness, feelings of hopelessness, and an overabundance of ANTs (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 DL-phenylalanine (DLPA), L-tyrosine, and S-Adenosyl-Methionine (SAMe).

DLPA is the amino acid precursor for norepinephrine. In a number of studies norepinephrine and epinephrine (adrenaline) have been shown to be low in ADD and depression. The antidepressants imipramine, desipramine, and a new one, Reboxitine, work by increasing norepinephrine in the brain. DLPA, by boosting norepinephrine’s precursor, can have a positive impact on mood and focus. In fact, in a number of studies DLPA has been found to be helpful for depression, energy, and pain control. I have used it for fifteen years as a mild antidepressant in children, teens, and adults. It is more mild in its effect than prescribed antidepressants, but it also has significantly fewer side effects. People who have PKU (phenylketonuria) should not take DLPA, as they do not have the enzyme that metabolizes it. I recommend doses of 400 milligrams three times a day on an empty stomach, half that dose for children.

Victor, a seventeen-year-old high school senior, came to see me at his own request after I did an assembly lecture at his school. He said that he often felt negative, had too many ANTs, and was always disorganized. He didn’t want to take medication, but wanted to know if there were “natural things” he could do. I had him exercise, eat a more balanced diet, and take 400 milligrams a day of DLPA. Within two weeks he called me and said that he felt much better, more focused, more energetic, and more positive. He recently wrote me from college saying he had remained faithful to his regimen and continued to feel well three years later.

Another effective supplement for treatment of Type 5 ADD is SAMe. Involved with the production of many important brain compounds, such as neurotransmitters, SAMe’s unique chemical action (it’s called a methyl donor, a rare property) helps the brain to 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 increases the neurotransmitters involved with depression and improves cell membrane fluidity. SAMe is one of the best natural antidepressants available, and 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 commonly coexist. 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. The dosage of SAMe is between 200 and 400 milligrams two to four times a day, half that for children.

TYPE 6 (RING OF FIRE) ADD

Type 6 (Ring of Fire) ADD is often associated with fierce ADD symptoms, such as intense hyperactivity and distractibility, severe impulsiveness, hypersensitivity to the environment, pressured speech, and cyclic mood changes. This type of ADD may be related to bipolar disorder. Stimulants tend to make it worse. However, we have seen that GABA, 5-HTP, and L-tyrosine, plus fish oil have a positive effect on Type 6 (Ring of Fire) ADD. As discussed, GABA has a calming effect on nerve cells, 5-HTP, helps calm the anterior cingulate hyperactivity, and L-tyrosine helps to balance brain function.

Here’s an example of how the right supplements can literally change someone’s life. Sam was fourteen years old when he first came to see us. His father had a friend who came to our clinic and bought him a copy of the first version of this book. The father saw the Ring of Fire pattern in Sam. He was argumentative, angry, moody, inattentive, hyperactive, easily distracted, and very sensitive to noise in the environment. He had tried a number of traditional treatments without success. His SPECT study showed a very severe Ring of Fire pattern with diffuse cortical hyperactivity. We put him on a combination of GABA, 5-HTP, L-tyrosine, and omega-3 fatty acids. Within two months he was dramatically different. The repeat SPECT study was significantly improved.

TYPE 7 (ANXIOUS) ADD

The supplements most effective to help this type of ADD are those that help calm and soothe the brain. B vitamins help support healthy relaxation, especially B6 and inositol, as does L-theanine from green tea (200 milligrams two or three times a day). Relora (750 milligrams two to three times a day) is another favorite of mine, as it helps to block the release of cortisol, the main stress hormone. Magnesium (100 to 300 milligrams two to three times a day) is another calming supplement that can be very helpful, especially for sleep and muscle twitches. Holy Basil (200 to 400 milligrams a day) is an adaptogenic herb that we have also found useful to help people focus and feel more relaxed.