Are Doctors Sugar-Coating Attention Deficit Diagnoses?
By Ward Dean M.D.
A recent communication with a concerned grandparent has brought up an interesting medical-health care phenomenon which I thought would be of interest to many readers, including physicians as well as laypeople. This worried grandfather wrote to me asking for a nutritional alternative to Ritalin. He wrote in his letter that his grandson was recently diagnosed with Attention Deficit Disorder (ADD), and the physician prescribed Ritalin. In his letter, he wrote, I understand that Ritalin is an amphetamine speed and I am opposed to this treatment. Is there anything that we can use nutritionally to avoid the use of what I believe to be a dangerous and addictive medication?
In response to this mans letter, Id like to say that I believe the current epidemic of ADD is actually a created phenomenon. Certainly, there are children who suffer from what was formerly termed minimal brain dysfunction. But, many children who are undeservedly tagged with this diagnosis are merely normally active children. Children are naturally energetic and curious. However, in this daycare-oriented society, the good child is often considered to be the one who sits quietly and says or does nothing. The child who is often referred for evaluation (inappropriately, I believe) for hyperactivity is the normal, active child who climbs the bookcases, pulls toys off the shelves, and runs around playing with his friends. Usually, these children tend to be highly intelligent, and, I believe, they are bored by their environment (classroom or daycare) which fails to challenge them intellectually or physically.
Attention Deficit Disorder: The Diagnosis that ADDs Up!
A major contributing factor to the ADD epidemic is the little-known fact that public (government) schools all have federally-supported programs for the learning disabled. The more children who are diagnosed with ADD, the more federal money the schools receive, giving public schools a tremendous incentive to maintain as high a number of children with ADD as possible. Link this to the psychologists and physicians to whom these children are referred for evaluation and treatment and who also have a definite financial incentive for making a high percentage of positive diagnoses and we can understand why so many children are (mis-) diagnosed with ADD.
The Disorder that Starts at the Breakfast Table?
I believe that an unrecognized cause of ADD is often hypoglycemia (low blood sugar). The cause of this condition is, paradoxically, the ingestion of too much carbohydrate (sugar). Browse through the cereal aisle of any grocery store, and read the labels of the breakfast cereals. After a main ingredient, which may be rice, wheat, corn or oats, youll discover a list of ingredients which probably includes sugar, fructose, corn syrup, dextrose, brown sugar, maltodextrin, and/or honey–a veritable feast of refined carbohydrates. Children are normally very efficient in metabolizing carbohydrates. This carbohydrate load causes a rapid rise in blood sugar and a concomitant rapid rise in insulin. The insulin drives the sugar from the blood into the cells, resulting in a dramatic fall in blood sugar (hypoglycemia). This crash usually occurs one to two hours after breakfast, right in the middle of morning class! Hypoglycemia can cause a number of changes: physical, mental and emotional. These changes may manifest as aimless hyperactivity (or underactivity), loss of attention, inability to concentrate and emotional instability (surliness, screaming, crying and meanness), turning a normal child into a totally different person, almost a Jekyll & Hyde transformation, like someone who might be considered to have ADD and who should be treated with Ritalin.
I cant tell you the number of ADD-diagnosed children of my patients who have become normal after they were given a high-protein, high-fat, low-carbohydrate breakfast instead of the usual fare of cereal, white toast & jelly, doughnuts, etc. I recommend such children be given poached eggs, bacon or ham for breakfast. This results in a sustained,
slow release of sugar throughout the morning, usually lasting until lunch. For lunch, instead of spaghetti, macaroni and cheese or other high-carbohydrate meals, give a tuna or peanut butter sandwich (read the label, use peanut butter without sugar) or other high-protein, low-carbohydrate food. Upon returning home from school, imwww.ely provide another high-protein, high-fat, low-carbohydrate snack. This often eliminates the crying, fighting or other tantrum-like behavior after school. Finally, eliminate the fruit roll-ups or other high-sugar snacks and especially stimulating or addictive caffeine-containing cola soft drinks. It should be noted that most grains (rice, wheat, oats, etc.) have an extremely high glycemic index, very close to that of sugar.
When a child is clearly acting hypoglycemic, parents must be aware of these acute, emotional turnarounds in a normal, happy, outgoing, friendly child, give him a glass of orange juice or other fruit juice to cause a rapid rise in blood sugar, followed by a high-protein, high-fat snack to sustain the normalized blood sugar and prevent another crash. I have often found it necessary to feed many hyperactive children (especially my own!) every two hours in order to maintain a state of normal behavior, with extremely gratifying results.
Food Allergy or ADD?
Another not-infrequent cause of behavior inconsistent with ADD is food allergies. I have found the most common allergens to be milk, corn or wheat. A frequently heard comment in my medical office is He cant be allergic to _______! Thats his favorite food! Allergy-induced behavior problems are often accompanied by a history of frequent colds and ear infections and tubes in the ears.
DMAE: A Safer & More Effective Solution
Finally, for those children who really do have minimal brain dysfunction and even for those who dont I recommend use of the time-honored and extremely well-tested nutritional supplement, DMAE (dimethylaminoethanol). DMAE has been used for years to improve behavioral disorders in children, and may have positive effects on intelligence and grades as well.
In 1958, Dr. Leon Oettinger, Jr., found that DMAE:
- Accelerated mental processes
- Improved concentration span
- Abolished early morning fogginess
- Relieved lassitude and mild depression with obvious letdown when it was discontinued
- Was useful in schizophrenia of long duration (with prolonged treatment)
- Decreased irritability and reduced overactivity, leading to a much better overall social adaptation and improved scholastic functioning
- Increased attention span
- Did not cause drowsiness
- Actually improved IQ!
Furthermore, he found that DMAE had numerous advantages over the amphetamines (like Ritalin) in that there were no effects on heart rate or blood pressure and no induced jitteriness. Instead of causing anorexia (loss of appetite) like the amphetamines, he found that DMAE actually improved appetite in many patients and caused no interference with sleep. In fact, he found that DMAE actually reduced sleep requirements. Dr. Oettinger concluded that DMAE was a most useful tool in the handling of the child with behavioral problems. (1)
In 1960, Dr. Stanley Geller reported on a double-blind study of 75 children, that DMAE in doses of 50 mg twice daily resulted in improved functioning capacity, puzzle-solving ability and organization of activity.(2)
Kugel and Alexander reported that DMAE had also been demonstrated to be useful in the treatment of chronic fatigue and depression in children. This study also looked at 42 emotionally-disturbed children, with a mean IQ of 78 (35 of whom had frank encephalopathy). They found no differences between DMAE and placebo. However, they conceded that the dosage used (100 mg per day) might have been inadequate for the severity of the conditions that were treated in their study. This group was comprised of children who were certainly not typical of most of those with ADD. (3)
In another double-blind study of fifty children who had been diagnosed as suffering from hyperkinetic syndrome, DMAE was administered in doses up to 500 mg/day (300 mg in the morning, another 200 mg at lunch). The author concluded that DMAE, when administered at doses of 300-500 mg per day for 12 weeks to moderately disturbed hyperkinetic children (six to 12 years of age) produces greater overall improvement in comparison to patients similarly treated with a placebo. (4)
As you can probably surmise from the above, I am not a great fan of Ritalin, nor a believer in the widespread over diagnosing of ADD. I believe learning and behavioral disabilities in children have a number of causes and that the vast majority are due to hypoglycemia and/or food allergies. I do not believe that Ritalin, although effective, is a panacea. Furthermore, I believe that Ritalin has more drawbacks than benefits: (1) dependence or addiction; (2) anorexia, leading to growth and developmental problems; and (3) sleep disturbances, further exacerbating learning problems. An additional consequence of Ritalin use is the recent determination by the Armed Services that a history of Ritalin use is a disqualifying condition for entry into the Army, Air Force or Navy.
Prior to using Ritalin, I would attempt to determine if there is a metabolic cause of the learning/behavioral problems. I would dramatically alter the diet, cutting out simple carbohydrates and increasing quality proteins and fats (eggs, fresh fish, chicken and meat, butter, coconut oil, olive oil, etc.). I would also prescribe the liberal use of vegetables, limited fruit, and rotational avoidance of milk, corn and wheat (to rule out food allergies). I would institute the use of DMAE, in doses beginning at 100 mg in the morning, advancing the dosage as tolerated to 500 mg per day in divided doses.
Next month: James South provides additional information on this topic and discusses the value of magnesium and grape seed extract supplementation in treating ADD.
Oettinger, L. The use of Deanol in the treatment of disorders of behavior in children. J. Pediat, 1958, 53: 761-675.
Geller, S. J. Comparison of a tranquilizer and a psychic energizer. JAMA, 1960, 174: 89-92.
Kugel, R. B., and Alexander, T. The effect of a central nervous system stimulant (Deanol) on behavior. Pediatrics. 1963, 31: 651-655.
Coleman, N., Dexheimer, P., Dimascio, A., Redman, W., and Finnerty, R. Deanol in the treatment of hyperkinetic children. Psychosomatics, 1976, 17: 68-72.