Course Description:

Scientific evidence confirms ADHD to be a neurologic, brain-based disorder represented by numerous biological abnormalities.  What is observable as atypical behavior is merely the tip of an iceberg that extends down to an individual’s unique biochemical makeup. Certain nutritional imbalances, which can profoundly impact cognition and behavior, are significantly correlated with this common disorder. Health-care practitioners, however, often overlook diet, micronutrient status, and individual biochemistry in ADHD treatment and assessment.

Fortunately, addressing nutritional imbalances with an integrative treatment plan has proven effective in treating ADHD.  This three-module course will introduce Dr. Greenblatt’s breakthrough Plus/Minus plan for ADHD and provide a comprehensive overview of the biochemistry ‘beneath’ the disorder.  Dietary interventions and augmentation strategies for the mitigation of specific nutrient deficiencies will be reviewed, as well as recommendations for going “beyond biochemistry” to enhance treatment outcomes.

CME Accreditation (AAF)
This Enduring Material activity, Integrative Medicine for ADHD, has been reviewed and is acceptable for up to 4.00 Prescribed credit(s) by the American Academy of Family Physicians.  AAFP certification begins 09/01/2019.  Term of approval is for one year from this date.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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1. Finally Focused - Redefining the Treatment Model for ADHD

Module 1 will provide a brief overview of the dilemmas, obstacles to treatment, and misconceptions surrounding ADHD, and seek to redefine this common disorder.  Evidence supporting a neurobiologic model of ADHD will be presented, along with a powerful rationale for implementing treatments that are, accordingly, neurobiologic and which have been demonstrated to effectively treat ADHD symptoms.  Genetics, environmental toxins, and dietary factors will be discussed with regard to their etiologic influences, and studies supporting the role of nutrition in ADHD pathogenesis will be objectively reviewed.

2. The Role of Diet in ADHD - Macronutrients

With research demonstrating a clear and consistent link between poor diet and ADHD, it is essential that today’s clinicians understand the functional role of nutrition in cognitive and behavioral health.  In this module, Dr. Greenblatt will review macronutrients – lipids, proteins, and carbohydrates – as they relate to ADHD pathogenesis and pathophysiology.  Factors contributing to altered glucose metabolism, commonly observed in ADHD populations, will be explored, and the rationale for the implementation of a hypoglycemic diet will be discussed.  The biologic functions of dietary lipids will then be examined, with an emphasis on the mechanisms by which essential fatty acids (EFAs) and cholesterol impact neurotransmission.  Studies corroborating the link between low cholesterol, aggression, and suicidality will be presented, as well as evidence demonstrating correlations between cholesterol, oppositional behaviors, and ADHD symptom severity.  Genetic factors affecting lipid absorption, utilization, and transport will substantiate the need for personalized testing in ADHD treatment, and guidelines for EFA supplementation and augmentation will be detailed.  Next, Dr. Greenblatt will discuss amino acids: their relation to neurotransmitter synthesis and behavior, factors that can alter protein digestion and metabolism, and strategies for supplementation.  The essential functions of vitamin D, a nutrient correlated with a wide range of neurologic and behavioral disorders, will then be explored, as will the importance of achieving vitamin D repletion as part of a functional ADHD treatment approach.  Finally, the therapeutic applications of oligomeric proanthocyanidins (OPCs) will be discussed in the context of EEG studies revealing abnormal patterns of brain activation in individuals with ADHD.

3. The Role of Diet in ADHD - Macronutrients

Module 3 will provide an in-depth examination of micronutrients that research has confirmed to be strongly associated with ADHD, with a special emphasis on trace metals.  Environmental and dietary sources of lead and copper, both of which are significantly correlated with ADHD presentations, will be reviewed, and the mechanisms by which they precipitate neurologic dysfunction will be elucidated.  Obstacles to the quantification of trace metal and trace mineral status will support a rationale for the inclusion of hair analysis in integrative assessment protocols, and orthomolecular strategies for balancing copper and zinc to alleviate ADHD symptoms will be presented.  Dr. Greenblatt will then review phosphorus, magnesium, iron, and lithium, micronutrients which can significantly impact therapeutic trajectories and which, therefore, occupy significant places in the Plus/Minus plan.  Guidelines for testing, recommendations for supplementation and augmentation, and specific clinical pearls will be provided, with an emphasis on the practical ramifications of biochemical individuality in the treatment of this complex, multifactorial disorder.  The module will conclude with a thoughtful examination of benefits associated with moving ‘beyond biochemistry,’ and a discussion about why it is so important that we not only instruct our ADHD patients… but also listen to them.


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Learning Objectives:

Upon completion of this course, registrants will be able to:

  • Substantiate a neurobiological model of ADHD by elucidating specific biologic and environmental factors associated with ADHD pathogenesis
  • Explain why a functional, actionable understanding as to the role of nutrition in health is not ‘alternative medicine’
  • Elaborate on the empirically supported relationship between diet and ADHD risk
  • Elucidate the acute and chronic effects of refined sugar consumption, and explain how these effects relate to behavior
  • Elucidate the mechanisms through which cholesterol and essential fatty acids influence neurotransmission
  • Explain why dietary intake is not always a reliable indicator of serum cholesterol / lipid levels
  • Explain why dietary intake is not always a reliable indicator of amino acid levels
  • Identify intrinsic and environmental factors that can contribute to an amino acid deficiency
  • Describe the clinical significance of results from tryptophan depletion studies as they relate to ADHD
  • Elucidate the role of vitamin D in serotonergic pathways, and explain why achieving vitamin D repletion is essential for achieving success with other ADHD interventions
  • Describe the clinical significance of increased [EEG] theta wave activity, decreased beta wave activity, and an increased theta:beta ratio
  • Elucidate the mechanisms through which OPCs can benefit ADHD patients
  • Identify trace metals that should be tested in any child presenting with ADHD-type symptoms, and explain the rationale for doing so according to a functional medicine model
  • Explain the functional relationship between copper and zinc, and the neurologic ramifications of an abnormal Cu:Zn ratio.
  • Elucidate the role of zinc in neurotransmitter synthesis, digestive enzyme synthesis, and melatonin synthesis
  • Explain why clinical symptoms may be more reliable than blood levels as indictors of a patient’s magnesium status
  • Identify behavioral manifestations associated with lithium deficiency
  • Explain why broad-spectrum micronutrient formulations may not be ideal for ADHD patients
  • Elaborate on the potential long-term consequences of un-treated ADHD
  • Substantiate the benefits associated with incorporating exercise into integrative treatments for ADHD
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