Article in ADDITUDE Magazine received as Google Alert in email on Oct.19.

09 Beyond Meds Nutrition makeovers, brain training, and simple breathing exercises may ease ADHD symptoms without side effects. What you should know about each of these approaches.

Sean Sims at New Division There isnt a magic bullet that manages all symptoms of ADHD, says Richard Brown, M.D., associate clinical professor of psychiatry at Columbia University College of Physicians and Surgeons and co-author of How to Use Herbs, Nutrients, and Yoga in Mental Health Care. Stimulants are good medicines, and Im glad theyre there, but they dont do the whole job, and theyre not for everybody. Says Dr. Ned Hallowell, author of several best-selling books on ADHD: If the only feedback a doctor gives you after a diagnosis of ADHD is a prescription for a stimulant, think about finding a new doctor. Medication isntand shouldnt bethe only treatment for the condition. Many parents seek alternatives for their children because of concerns about a medications side effects and the potential for its abuse. A study found that 54 percent of parents used complementary and alternative therapies for their children with ADHD, and only 11 percent discussed those therapies with their physicians. To be safe, adults with ADHD and parents with children who have the condition should always tell their doctor about alternative therapies theyre using, and shouldnt discontinue medication without a doctors consent.

On the following pages, we explore several alternative treatments ADD-friendly nutrition (what to eat, what to avoid, what supplements to take), exercises that firm and tone the brain, and breathing techniques that will calm you down and increase attention. (Stay on top of alternative therapy research on ADHD by reading the news section of additudemag.com and by visiting PubMedpubmed.govfor the latest studies on ADHD.) Attention on Nutrition The right foods, supplements, and herbs can prevent ADHD symptoms from swinging out of control. Lisa Vohra knows one thing for sure: If her eight-year-old daughter, who has ADD, eats sweetsor, for that matter, any simple carbohydratesshed better get some protein, too. Ive explained to my daughter that she needs protein with carbs, so her blood sugar wont spike, says Vohra, a stay-at-home mom, from Virginia. With the inevitable drop in blood sugar that follows a spike, she becomes unfocused. So, instead of a breakfast bar with 20-plus grams of sugar, her daughter often starts the day with an egg. And lunch is frequently made from protein-rich leftovers from the previous evenings supper, with nuts or soy chips for an afternoon snack. Vohra says that using protein to buffer her daughters carbohydrate intake has helped her daughter do better in school. In fact, her classroom behavior improved so dramatically that her teacher asked whether she had started taking medication. Poor eating habits do not cause ADD, but research suggests a strong relationship between ADD and the foods you consume. Read on to find out how to make your diet or your familysADD-friendly. WHAT TO EAT Deficiencies in certain types of foods can worsen ADHD symptoms in children and adults. Getting adequate levels of the right foods optimizes brain function. Protein. As Vohra discovered, foods rich in proteinlean beef, pork, poultry, fish, eggs, beans, nuts, soy, and low-fat dairy productscan

have beneficial effects on ADD symptoms. Protein-rich foods are used by the body to make neurotransmitters, the chemicals released by brain cells to communicate with each other. Protein can prevent surges in blood sugar, which increase hyperactivity. Because the body makes brain-awakening neurotransmitters when you eat protein, start your day with a breakfast that includes it, says Laura Stevens, M.S., a nutritionist at Purdue University and author of 12 Effective Ways to Help Your ADD/ADHD Child. Dont stop there. Look for ways to slip in lean protein during the day, as well. Balanced Meals. Faye Berger Mitchell, a registered dietician from Bethesda, Maryland, has a nine-year-old daughter who was diagnosed with ADHD two years ago. While her daughter takes stimulants to control her ADHD symptoms, Mitchell concluded that a pill is not enough. She finds that when her daughter eats a well-balanced diet, including vegetables, complex carbohydrates, fruits, and plenty of protein, her behavior tends to be more consistently under control. Ned Hallowell, M.D., founder of the Hallowell Center for Cognitive and Emotional Health, in Sudbury, Massachusetts, and New York City, advises all of his ADHD patients to think about their plates when preparing a meal. Half of the plate, he recommends, should be filled with fruits or vegetables, one-fourth with a protein, and one-fourth with carbohydrates. Hallowell also advocates eating several servings of whole grains, which are rich in fiber, each day to prevent blood sugar levels from spiking and then plummeting. WHAT TO TAKE Many diets are deficient in key vitamins, minerals, and fats that may improve attention and alertness, says Richard Brown, M.D., author of How to Use Herbs, Nutrients, and Yoga in Mental Health Care. He suggests that children and adults who have been diagnosed with ADHD be tested for nutritional deficiencies. Supplements and diet can correct nutrient shortfalls that exacerbate ADHD symptoms, adds Brown. Herbs may improve blood flow to the brain, increasing alertness while reducing aggressive behavior. Talk with your doctor, or a psychopharmacologist, before starting an herb regimen.

Omega-3 Fatty Acids. Omega-3s are believed to be important in brain and nerve cell function. A new study, conducted at Gteborg University, in Sweden, concluded that daily doses of omega-3sfound in coldwater, fatty fish, such as sardines, tuna, and salmonreduced ADHD symptoms by 50 percent. Dr. Sven Ostlund followed a group of ADHD children aged 8-18 who took fish oil daily. Within six months, there was a noticeable decrease in ADHD symptoms in 25 percent of the children. Another study showed that omega-3s tend to break down more readily in the bodies of patients with ADHD than in those without the condition. ADDers who have low blood levels of omega-3s will show the biggest improvement in mental focus and cognitive function, says Brown. Sometimes the change is dramatic. John Ratey, M.D., associate clinical professor of psychiatry at Harvard Medical School, recommends that you choose a supplement that contains more EPA (eicosapentaenoic acid) than DHA (docosahexaenoic acid). Zinc, Iron, and Magnesium. Zinc regulates the neurotransmitter dopamine and may make methylphenidate more effective by improving the brains response to dopamine. Low levels of this mineral correlate with inattention. Iron is also necessary for making dopamine. One small study showed ferritin levels (a measure of iron stores) to be low in 84 percent of ADHD children compared to 18 percent of the control group. Low iron levels correlate with cognitive deficits and severe ADHD. Like zinc, magnesium is used to make neurotransmitters involved in attention and concentration, and it has a calming effect on the brain. All three minerals are found in lean meats, poultry, seafood, nuts, soy, and fortified cereals. While diet is the safest way to increase all three mineral levels, a multivitamin/multimineral with iron will ensure that you or your child gets the daily reference value (DRV) of these minerals. B Vitamins. Studies suggest that giving children who have low levels of B vitamins a supplement improved some IQ scores (by 16 points) and reduced aggression and antisocial behavior. Vitamin B-6 seems to increase the brains levels of dopamine, which improves alertness, says Brown. Drugstore chains offer inexpensive, high-quality, store-brand Bvitamin formulations. Many of the studies on vitamin B and ADD used a Swiss formula called Bio-Strath (available at vitacost.com). It comes in pill and liquid forms.

Multivitamin/Multimineral. If your child is a picky eater, or if he eats lots of take-out food, chips, and soda, he probably isnt getting the daily recommended value of vitamins and minerals. A daily multivitamin/multimineral will ensure that he does, no matter how finicky he is. Heros Yummi Bears Multi-Vitamin & Minerals (heronutritionals.com) contain no artificial colors and flavors, which increase hyperactivity in some children with ADD. Picamilon. A combination of the B-vitamin niacin and gammaaminobutryic acid (GABA), picamilon improves blood flow to the brain and has mild stimulative effects, improving alertness and attention. It can also reduce aggressive behavior. Both adults and children derive benefits from this supplement, says Brown. Picamilon can be purchased at Smart Nutrition (smart-nutrition.net) and IAS (antiagingsystems.com). Ginkgo and Ginseng. These herbs are cognitive activators, says Brown. They act like stimulants, without the side effects. Typically, adults and children who take ginkgo and ginseng improve on ADHD rating scales, and are less impulsive and distractible. Asian ginseng may overstimulate younger children. If this happens, switch to American ginseng. Hsus Ginseng (hsuginseng.com) is a reliable mail-order source for both versions of the herb. According to Brown, Ginkoba (ginkoba.com) and Ginkgold (naturesway.com) are the best brands of ginkgo. Pycnogenol. An extract made from French maritime pine bark, pycnogenol was found to improve hyperactivity and sharpen attention, concentration, and visual-motor coordination in students after one month, based on standardized measures and teacher and parent ratings. The herb is also rich in polyphenols, antioxidants that protect brain cells from free radical damage. The first double-blind study on the herb was published in 2006, confirming its benefit, says Brown. Larger randomized trials, though, are needed. You can purchase pycnogenol from Natures Best (naturesbest.co.uk). Rhodiola Rosea. Made from a plant of the same name that grows in the Arctic, this herb can improve alertness, attention, and accuracy. It can be too stimulating for young children, and is occasionally beneficial in children ages eight to 12. It is most useful, says Brown, for students in

junior high, high school, and college, who have to complete long papers and spend hours reading. Rhodiola rosea is available from Ameriden International (ameriden.com), Swedish Herbal Institute-ProActive (proactivebio.com), and GNC (gnc.com). WHAT TO CUT BACK ON High-Sugar Foods and Snacks. Several studies suggest that some ADHD kids are turned on by copious amounts of sugar. One study concluded that the more sugar hyperactive children consumed, the more destructive and restless they became. A study conducted at Yale University indicates that high-sugar diets increase inattention in some kids. Some common items to avoid include fruit drinks or cocktails, both of which are higher in sugar than 100 percent fruit juice. Read food labels carefully, looking for the following ingredients (code words for sugar): high-fructose corn sweetener, dehydrated cane juice; dextrin; dextrose; maltodextrin; sucrose; molasses; and malt syrup. Artificial Dyes and Preservatives. Studies published in The Lancet, Pediatrics, and The Journal of Pediatrics suggest that some children with ADHD are adversely affected by food additives. A recent study indicates that artificial coloring and flavors, as well as the preservative sodium benzoate, make some non-ADD kids hyperactive. Avoid colorful cereals, like Fruit Loops and Lucky Charms. Cheerios are better, and lower in sugar. Substitute 100 percent fruit juice for soft drinks and fruit punches, most of which are artificially colored and flavored. If your child wants a treat, offer him Pepperidge Farm Chessmen cookies, which are free of dyes and low in sugar. Foods That Cause Allergies. According to studies, gluten, wheat, corn, and soy cause some children to lose focus and become more hyperactive. Vincent Monastra, Ph.D., author of Parenting Children with ADHD, suggests that all children be screened for food allergies before being prescribed medication for ADHD. Talk with your doctor about testing for allergies. Take a Deep Breath Slow, relaxed breathing clears your head, increases attention, and reduces anxiety. And a child can do it.

You have to breathe, so why not use your inhalations and exhalations to manage your ADHD symptoms? Several studies show that rhythmic, paced breathing balances the autonomic nervous system, says Richard Brown, M.D., associate clinical professor of psychiatry at Columbia University College of Physicians and Surgeons. What does that mean to someone with ADD? Controlling your breathing can help you become more attentive and more relaxed at the same time. Many of Browns ADD patients have benefited from coherent breathing a term coined by author and yoga specialist Stephen Elliott because the technique synchronizes heart, lung, and brain rhythms. Ethan, 10, has ADD. He couldnt sit still when doing homework, couldnt fall asleep, and was difficult to manage. He had a bad reaction to stimulants, and cognitive behavioral therapy didnt work. So Ethans mother, who had used coherent breathing to calm her own anxiety, taught him how to do it. His overall behavior improved in four or five weeks, and he fell asleep without difficulty. Whenever he felt stressed, or he felt like he wasnt meeting expectations at school or at homecommon occurrences for those with ADDhe would do the breathing exercises, whether he was taking a test at school or not getting along with classmates. The nice thing about coherent breathing is that, unlike yoga and exerciseboth very good therapies for ADDit is portable and accessible, says Brown. You can do it while youre at the office, riding the subway, or even in school. The Science of Breath Your autonomic nervous system (ANS) has two components: a stress response and a recharge response. An ADDers nervous system is out of whack: Most of the time the stress and recharge responses are underactive. But when an ADDers stress response kicks in, it goes into high gear, compared to those who dont have the condition. For your brain to work betterand for you to be less impulsive and hyperactiveboth components of the ANS need to work optimally and in the right balance. Coherent breathing can help accomplish these goals. Amazing things happen in the body and brain when you slow down your breathing to five or six full breaths a minute, says Brown, who

teaches a weekend course in coherent breathing (haveahealthymind.com). The heart, lungs, and blood vessels work more efficiently, delivering more oxygen to the bodys tissues and the brain. Parts of the brain that deal with complex problems begin to function better. Typically, you see a big change in brain-wave patterns meaning more healthy alpha waves and fewer sleepy delta waves. People with ADD feel a lot calmer, are better able to make good judgments, and are less easily frustrated, says Brown. How to Do It To master coherent breathing, its best to have some instruction. An instructor can tell you whether your muscles are relaxed, and whether youre breathing too deeply, says Brown. You can learn the technique in a weekend. The key is to practice at home for 10 to 20 minutes a dayuntil it becomes an automatic response to stress and hyperactivity. Find a quiet place to sit where you wont be interrupted. Close your eyes, relax your eyes, neck, hands, and feet, and complete five or six full breaths in a minute, keeping your awareness on the breath moving inside of you. (Respire 1, a CD by Stephen Elliott, is helpful, prompting you to inhale and exhale at set intervals. It is available at coherence.com.) One note: Practice coherent breathing when youre calm. A lot of people say, Oh, Ill do it when I get stressed. Thats like waiting to brush your teeth after theyve fallen out, says Brown. When you get upset with your boss, or when you lose your keys, youll have a head start at getting your calm and focus back if youve practiced. The technique becomes an almost automatic response when you find yourself in stressful situations. To take a course in coherent breathing, or to learn more about it, go to haveahealthymind.com or to coherence.com. Tune-Ups for the Brain Four therapies that bring more of the ADD brain onlineand keep it there.

People with attention deficit have an interesting brain wave profile, says Richard Brown, M.D. Parts of the brainareas responsible for planning and sequencing, making decisions, and maintaining focus arent functioning as they do in other people. Therapies aimed at sharpening those faculties are sometimes required. Working memory training Several studies conducted by the Karolinksa Institute, a medical university based in Stockholm, showed that five weeks of working memory training reduced symptoms of inattention and hyperactivity in children. Working memory is the ability to hold onto information long enough to accomplish a specific goal. You hold a task in mind as you work to accomplish it. Why It Works. When you improve working memory, you improve fluid IQthe ability to solve problems or adapt to situations as they occur. Most kids who complete memory training become more alert to their surroundings. They are also more alert to social cues. Parents often report that their kids become more mature. They take charge of their hygiene and do chores without being nagged. They remember to bring materials to and from school. Seventy-five to 80 percent of kids show improvement after memory training. At six-month and one-year followups, about 80 percent of subjects maintained their working memory gains or improved on them. How It Works. Cogmed (cogmed.com) developed software that trains working memory on a home computer. Exercises are in a video game formatwith colorful graphics and crisp sound. In one exercise, a child shoots down floating asteroids; in another, he recalls numbers in reverse order from which they are given. The training takes five weeks, five days a week, one hour a day. The cost ranges from $1,500 to $2,000, and it is not covered by most medical insurance plans. The Cogmed program does not claim to replace medication, but to manage symptoms that meds dont. Electrotherapy stimulation This approach, known as cranial electrotherapy stimulation (CES), sends low-energy electrical currentfrom a small, handheld device powered by batteriesto the skin and scalp muscles. The current

changes electrical patterns in the brain. I see two types of patterns in my ADD patients, says Brown. Many parts of the brain are sluggish, while some parts arent turned on at all. Other parts are hyperactive. The current balances them all out. Brown saw a patient who had ADD, significant mood swings, and learning disabilities. He was rough with kids at school, and he had no friends. He also had a porn addiction. The teen was taking large amounts of Adderall. Brown tried several therapies and reduced his medication dosage. Nothing seemed to help. Finally, he prescribed cranial stimulation. In a couple of weeks, the teen was a different person, explains Brown. He made friends at school, gave up his addiction, and has a clear career path. Latest Research. A review of studies on CES by Harvards School of Public Health suggests that low electrical voltages may influence neurotransmitter activityspecifically, the production of serotonin and dopamine, which some ADDers dont produce enough of. Brown points out that many studies suggest that CES benefits depression and anxiety. A recent study indicates that CES may benefit those with ADD. How It Works. Two companies, Fisher Wallace Laboratories (fisherwallace.com) and Alpha-Stim (alpha-stim.com), make cranial electrotherapy stimulators. The low-voltage stimulation is delivered via electrodes or clips attached to a persons earlobes. Professionals recommend that patients use the device for 20 minutes a day, until you see signs of improvement. The devices cost between $700 and $800, but both companies offer a 60-day money-back guarantee, says Brown. Most children and adults will see some benefit in two weeks. If it doesnt work for you, you can return it and get your money back. Low-Energy Neurofeedback The brain emits different types of waves, depending on whether we are in a focused state or daydreaming. The goal of neurofeedback is to teach a person to produce brain-wave patterns that reflect focus. The result: Some symptoms of ADHDimpulsivity and distractibilitydiminish. The low-energy neurofeedback system (LENS) works differently: It doesnt try to reproduce this or that brain wave but enhances the

brains ability to adapt to a task, whether it be a test in school or struggling to get along with friends. Developed by Dr. Len Ochs, in 1992, LENS has had extraordinary results using weak electromagnetic fields to stimulate brain-wave activity and restore brain flexibility. A controlled study of 100 subjects with different diagnosesADD, traumatic brain injury, bipolar disordershowed that 90 percent of them did better after LENS. How It Works. If you decide to undergo LENS treatment, a practitioner will first take a detailed family history and do a brain map. The map will show connectivity problemssites that are under-connected and over-connected, says Stephen Larsen, Ph.D., author of The Healing Power of Neurofeedback and a LENS practitioner at the Stone Mountain Center, in New Paltz, New York. Some sites of the brain are like a city in a blackout. Based on the map, the practitioner will treat four brain sites per session with radio frequencies, produced by a machine to which the patient is hooked up. The radio frequencies will gently stimulate those areas that are sluggish, and will take the edge off high-frequency sites. Most of the session is spent talking to the patient about whether the last treatment improved symptoms, says Larsen. LENS treatments cost between $75 and $150 per half-hour session. For more information on LENS, visit stonemountaincenter.com. To locate a practitioner near you, log on to ochslabs.com. Interactive metronome Developed in the early 1990s to help children with learning and developmental disorders, interactive metronome (IM) is used to improve planning and sequencing. The end result for ADDers: increased focus for longer periods, and the ability to filter out internal and external distractions. How It Works. IM challenges those with ADD to synchronize a range of hand and foot exercises to precise computer-generated tones heard through headphones. (The therapy is based on the regular clicking of the metronome used by musicians to help them mark time and keep a beat.) The patient attempts to match the rhythmic beat with repetitive motor actionstapping feet or clapping hands. A study conducted at

the College of Human Medicine at Michigan State University showed positive results in helping some children pay better attention and improve language and reading skills. How to Get Started. IM practitioners teach the therapy to children and adults in clinical and educational settings, including hospitals and schools. The cost ranges from $30 to $150 per session. Visit interactivemetronome.com for more information on finding a practitioner. 1 Comments:

Posted by edward jonathans - Oct 19 2009 @ 1:00 PM How it Works - Interactive Metronome; The entirely too brief paragraph doesn't acknoledge that Interactive Metronome treatment COMBINES all of the other individual _Brain Tune-Up_ functions cited above. Interactive Metronome at the foundational level functions to improve working memory. During IM you have to remember your last trigger response [did I hit too early or too late?] in order to achieve the appropriate trigger response on the next beat. IM's auto-difficulty function makes real-time adjustments using a proprietary algorithm that pushes us to perform movements with exact precision, thus continually challenging our working memory. wrt Electro Stimulation - IM retrains areas of the brain that are under performing [typically the Pre Frontal Cortex or PFC which controls the executive functions of planning, processing, sequencing] and motor cortex [gross motor skills]. IM also retrains over active brain centers [Amygdala / Cingulate Gyrus], areas which regulate emotional response. Because IM uses 13 various movement patterns that combine upper and lower body, bi-lateral and balance exercise motor skill exercises, we ensure that _what fires together wires together_. wrt - LENS, IM teaches us how to develop and extend our ability to focus and concentrate. When you are able to match the 54bpm reference tone [a cowbell] to within a +/- 15ms trigger response you are rewarded with a pleasant _guide sound_. Staying in that zone for four beats in a row earns a BURST [measure of short term focus]. Burst goals are used to drive intrinsic motivation and/or can be recognized with external rewards. Learning to extend time _In-

The-Zone_ develops the ability to sustain concentration over time. By creating a meditative state, IM is able to teach individuals how to self-regulate negative emotional response to frustration [inability to stay in the zone]. And lastly - it should be stated clearly that Interactive Metronome is not a _alternative_ therapy: IM is simply a MODALITY used in your overall treatment plan by a certified OT/PT/SLP.