Integrative Medicine 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.

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.

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.