The incidence of Attention-deficit hyperactivity disorder (ADHD) in children is on the rise in Canada. Why is this? It is not just genetics or bad luck. Environmental factors, like diet, do play a role, despite what conventional medicine might say.
In this article, we will discuss how environmental factors do play a role, the three critical elements that cause brain malfunction, the propionic acid theory, the cell danger response, the fact that there is no single root cause and the areas to focus on when treating ADHD.
ADHD now affects 5 percent of school children. That means that there are two children with ADHD in every class of 20 students. ADHD is a big issue.
We can not relate high incidence of ADHD to genetic factors alone because our genes do change that quickly. We know that some environmental factors are contributing to this increase in ADHD.
This fact is interesting because if you look at the mainstream medical websites they tell you that there is a genetic predisposition, but otherwise there are no real known causes. Some sites will go out of their way to say that diet has never been shown to be a cause.
There is quite a bit of evidence that suggests that diet—at least indirectly—is a major contributing factor to ADHD, as well as many other environmental factors.
I think that genetics are likely to play a relatively small role in ADHD, along with every other chronic condition. Genetics certainly play a role regarding predisposition, and we’re going to talk more about that in a little bit. But genes are not driving ADHD, and that should be obvious given the steady increase.
At this point, I want to talk about a recent research paper that I think is relevant to ADHD.
This paper was looking at what causes autism spectrum disorder (ASD). The title of the paper was “Enteric Ecosystem Disruption in Autism Spectrum Disorder: Can the Microbiota and Macrobiota Be Restored?”
Of course, ADHD and ASD, are not the same thing, but they possibly share a shared collection of causes.
What ASD and ADHD share in common is that the brain is not functioning correctly. The symptoms of how the brain is malfunctioning are different in ADHD and ASD, but they may share a lot of similar mechanisms.
In this regard, I would like to take a look at this paper as a way of highlighting the things that we should investigate when working with children with ADHD.
The authors of the study talk about a “three hit paradigm” in the paper or three hypotheses. The three theories are:
1. Biome depletion
2. Environmental stimulus
3. Genetic or epigenetic predisposition
1. Biome Depletion
The biome depletion hypothesis suggests that alterations of the microbiome are a consequence of our increasing hygiene.
Increasing hygiene leads to eradication of helminths, parasites, and other organisms that we co-evolved with over millions of years. These organisms help regulate and support our immune system.
A poorly working immune system may contribute to, not only autoimmune conditions but also conditions like autism spectrum disorder and ADHD.
2. Environmental Stimulus
Environmental stimuli are factors that may trigger ADHD including:
• Poor diet
• Eating too many refined and processed foods (including sugar)
• Vitamin D deficiency
• Excess antibiotic exposure
• Acetaminophen exposure
Acetaminophen, also called Paracetamol, is a chemical compound used as an analgesic and antipyretic, which is one of the most common drugs used and prescribed in the world.
Children are given Acetaminophen on a regular basis. There is some researchsuggesting that Paracetamol can be a contributor to autism spectrum disorders and possibly ADHD via similar mechanisms.
If exposure to these environmental stimuli happens at critical times during brain development early in a child's life, then they can have long-lasting effects.
3. Genetic/Epigenetic Predisposition
Not all children have ADHD and ASD, even if they have microbiota depletion and environmental stimuli.
So why do some youngsters get it and other children do not?
We can explain this question through genetics and epigenetics.
Genetics and epigenetics play a role regarding predisposing how children respond to exposure to external stimuli.
One kid might develop ASD, while another might get ADHD, and another might develop an autoimmune disease like Celiac Disease.
There is an assortment of ways in which these triggers can manifest regarding symptoms, and that is determined primarily by genetic and epigenetic factors.
Another interesting theory that the researchers mentioned is the Propionic Acid Theory.
This theory suggests that disturbances in the gut microbiota lead to an increase in production of a short-chain fatty acid called propionic acid.
The bacteria in the gut produce different short-chain fatty acids including propionic acid and butyrate.
Butyrate and propionic acid have different functions.
Butyrate is anti-inflammatory and immunoregulatory.
Propionic acid, on the other hand, if found in surplus, can change metabolic and immune pathways, gene expression, and synaptic plasticity in a way that is consistent with the findings of ASD and ADHD.
One of the researchers that is studying these theories, Derrick MacFabe, has performed some fascinating experiments where they infuse propionic acid into the brains of rats or mice. Afterwards, these animals exhibit behaviour that is very consistent with ASD models.
The propionic acid theory is probably another mechanism by which disruption of the gut flora leads to changes in brain function, including ASD-like behaviours and ADHD-like behaviours.
The third theory that the researchers mention is the cell danger response (CSD).
The CSD theory is something that has been put forward by Robert Naviaux, a researcher in San Diego at UCSD.
This theory refers to an adaptive response by the cell to a perceived threat.
Adaptive responses are typical responses that are appropriate especially in short-term response to a particular threat.
If adaptive responses become stuck or chronic due longterm exposure to external stimuli that can cause problems.
A good example would be the stress response. The stress or fight or flight response is beneficial when we are exposed to a threat because the stress response helps us to either run away or fight.
This response was instrumental while humans were evolving.
For example, if a human were out on the savannah in Africa walking and came face to face with a lion, the adaptive or stress response would lead to an increase in heart rate and blood flow to the muscles.
This response helps the human to survive that immediate threat.
However if that fight-or-flight response becomes chronic, as it does in the modern world, where that stress response is continually activated, then something that was adaptive in short can become maladaptive over the long term and create a lot of difficulties.
The cell danger response is a similar kind of circumstance where you have an adaptive positive short-term reaction that happens in the cell that becomes chronic.
This cell danger response causes changes in cell function.
Cells are the framework of the entire body. Everything in the body is made up of cells, so if the cells are dysfunctioning, then the whole body not going to work including the brain.
Lastly, we would expect the cell danger response to affect the mitochondrial function of the cell.
Mitochondria are the power factories of the cell, and mitochondrial dysfunction has been shown to be a common mechanism in ASD, ADHD.
ADHD – A Gut-Brain Disorder
So, the research paper gives a good overview of the underlying factors that may be contributing current understanding of ADHD.
From our current understanding, we could think of ADHD as a sort of gut-brain disorder.
This fact is true of a lot of other behavioural and psychiatric conditions like anxiety and depression.
Even Parkinson’s and Alzheimer’s Disease now are increasingly thought to have a gut-brain element.
Given our current understanding, let us talk about what to consider from a practical perspective for treating ADHD.
Unfortunately, it is difficult to give a definite protocol because the etiology of ADHD is multifactorial.
Multifactorial means it can have many different causes in different people.
The good news is that all of the above fundamental factors that can contribute to ADHD are things that we can focus on and treat without taking drugs that can alter brain chemistry.
Key Areas Of Focus
Nutrient status
The first area to look at would be nutrient status. That means ensuring a child has adequate amounts of zinc, copper, choline, B12, iron, folate, and vitamin A. Before testing we may achieve sufficient nutrient status by ensuring that the child is eating a nutrient dense wholefoods diet.
Adequate vitamin D status is also essential, and sometimes that can be achieved with diet and sun exposure, but in other cases supplementation will be necessary.
Toxin exposure.
There is lots of researchto support that that toxin exposure is a contributor to ADHD. So lessening exposure to toxins in food and the environment, implementing a safe detox and making sure the detoxification systems are working is very important.
Heavy metals.
Researchshows that there is a powerful connection between ADHD and heavy metals. So testing any child who has ADHD for heavy metals is an important consideration. Mercury, arsenic, lead, and cadmium can be instigators, and unfortunately, high levels in children are quite common.
Gut Microbiome.
The gut microbiota should be a primary focus for all of the above reasons. We know that a disruption in the gut microbiota can cause a lot of adverse effects on the brain including was an increase in propionic acid. We would want to identify and treat potential concerns like fungal overgrowth, parasites, bacterial pathogens, and Small Intestinal Bacterial Overgrowth(SIBO).
Short-Chain Fatty Acids (SCFAs)
Specifically, we want to view the balance of SCFAs, especially whether butyrate levels are low, and if propionic acid levels are high.
Unfortunately, both these SCFAs are somewhat difficult to measure. Some stool tests do measure production of butyrate and propionic acid, but they are imperfect.
Since testing is not possible in children who have ADHD, we have to assume that propionic acid production might be elevated.
We then want to implement all the usual strategies to fix the gut such as bone broth, a nutrient-dense diet, fermentable fibres, fermented foods to help the gut microbiota, decrease propionic acid and increase butyrate production.
Introducing prebiotics are great for promoting butyrate because they feed the beneficial bacteria that produce butyrate, like Bifidobacteria.
You can supplement with butyrate.
Up until very recently, butyrate supplements have not been all that effective, especially oral supplements, because they tend to dissolve in the stomach and not make it to the colon, where they are needed.
Butyrate enemas are an option for some patients in some cases which is more effective because you are delivering the butyrate to the colon.
There is a new form of oral butyrate coming out soon, that is encapsulated in such a fashion where it is released in the colon.
You can find out more about them at tessmed.com.
Antibiotics.
Research has shown that antibiotics have a detrimental effect on the gut microbiota.
For any child, you want to reduce exposure to antibiotics as much as possible.
Of course, antibiotics can be lifesaving and necessary, and I am not suggesting you should never use them, but you should use them judiciously and wisely.
Doctors may often prescribe antibiotics for ear infections. But if you view the researchon ear infections, many of them are viral, and many of them are self-limiting, which means they will heal with or without antibiotics at the same rate.
Diet
Above and beyond implementing a nutrient-dense diet, it may be worth trying a GAPS or a ketogenic type of diet.
In some cases, the suggestion is that a disruption in the gut microbiota is producing chemicals that affect brain function.
So, restricting carbohydrate-rich foods can be very helpful in rebalancing the gut microbiota and reducing the production of these chemicals.
You would want to do that under the supervision of healthcare practitioner who knows how to work with these diets because you want to make sure that they are getting all of the nutrients that they need.
HPA axis
Another essential part would be to support the hypothalamic–pituitary–adrenal axis, HPA axis often referred to as the adrenals.
Circadian entrainment is relevant to kids as well as adults, which means not getting too much exposure to light at night.
For example, not using their iPad in bed before falling asleep, removing the phone from the room, making sure they receive exposure to bright light during the day, not spending too much time indoors, and managing their stress.
Youngsters are under a lot of stress, notably in this modern age, mainly as they get into their adolescent years.
We often forget that stress is significant for youngsters as well as adults.
Stress is the most significant risk factor for mitochondrial dysfunction, which as I mentioned, is an issue in many of these cases.
Mitochondrial function
We want to look at other ways of improving mitochondrial function.
In this respect, we should consider the presence of any underlying infections. So that could be viral infections or reactivated viral infections like Epstein-Barr, tick-borne illnesses like Lyme, Bartonella or Babesia if they have had exposure.
We want to look at methylation, test for methylation and treat that preferably with diet if possible but sometimes methyl donor supplementation may be required.
In some cases, if addressing all of that, the mitochondrial function is still impaired, we might want to consider supplements like CoQ10, ubiquinol, PQQ, creatinine, L-carnitine, and B-vitamins.
Genetic testing
Finally, it is sometimes helpful to do more advanced genetic testing.
Genomics is the best way of approaching this issue.
Genetics looks at single genes and their purpose, but genomics looks at the connection between all of the genes, and epigenetics is looking at the character of those genes.
In some instances, we want to look at the genomic background to see what polymorphisms they have in genes that are known to affect brain function and may be linked to ADHD, and that can help steer some of the diet, supplement, and lifestyle choices.
As you can see, there’s a lot to consider when investigating and treating ADHD so if you are feeling overwhelmed I would focus on nutrient status, the gut and mitochondrial function.
As you can probably deduce doing this process with a functional medicine practitionerwho has a comprehension of these concerns and how to test for and treat the issues is going to produce the best results probably, but there’s a lot you can do on your own.
Hopefully, some of the ideas I have shared so far will give you a good head start. You can make some headway that way even without working with the practitioner.
