Presentation Transcript

1. ADHD Research Update- An Insider’s View

2. Artificial Food Dyes, Preservatives and ADHD

3. Artificial Food Dyes Three decades of studies on artificial food dyes and ADHD have established that: Existing ADHD can be aggravated by artificial food dyes. Prescrire Int. 2009 Oct;18(103):215 Center for Science in the Public Interest Photo credit: Moira Donahue Elimination diets can significantly improve symptoms in a majority of children with ADHD. Ann Allergy. 1994 May;72(5):462-8 Ned Tijdschr Geneeskd. 2002 Dec 28;146(52):2543-7
4. Artificial Food Dyes Recent studies have extended the findings to children in the general community. Lancet. 2007 Nov 3;370(9598):1560-7 Am J Psychiatry. 2010 Sep;167(9):1108-15 Community volunteers 300 children – 3 year olds and 8/9 year olds
5. Artificial Food Dyes Interviews Parents ADHD scale Teachers ADHD scale Classroom observation Connors CPT 1) Wash out week 2) Alternate dye and no dye weeks
6. Artificial Food Dyes MIX A: sunset yellow (FD&C Yellow 6), carmoisine, tartrazine(FD&C Yellow 5), ponceau 4R(banned US),sodium benzoate MIX B: sunset yellow (FD&C Yellow 6), carmoisine,quinoline yellow, allura red (FD&C Red 40 )sodium benzoate “Dose” of dyes was approximately 10% of the average daily food dye consumption in the US. National Academy of Sciences 1977 red 40natural flavor blue 2 turmeric coloryellow 6annatto colorblue 1
7. Artificial Food Dyes Both age groups showed a significant increase in ADHD symptoms when exposed to the food dyes Lancet. 2007 Nov 3;370(9598):1560-7 = Center for Science in the Public Interest Photo credit: Moira Donahue
8. Artificial Food Dyes

   Example: sunset yellow (FD&C Yellow 6)

   FOODS:Apple Jacks, Jello pudding, orange squash, orange jelly, marzipan, Swiss roll, Irn-Bru, apricot jam, citrus marmalade, lemon curd, sweets, hot chocolate mix and packet soups, trifle mix, breadcrumbs and cheese sauce mix and soft drinks, astropeach yogurt (potentially others), fortune cookies, some red sauces, certain pound cakes, snack chips and other yellow, orange, and red food products. Sunset Yellow is often used in conjunction with E123, Amaranth, in order to produce a brown coloring in both chocolates and caramel. MEDICATIONS:DayQuil(in high concentrations), some extra strength Tylenol PERSONAL CARE PRODUCTS:Lipstick (688) Makeup (General) (342) Lip Gloss (206) Hair Care (General) (124) Shampoo (91) Moisturizer (76) Blush (74) Body Wash & Cleanser (60) Conditioner (53) Bath & Shower (General) (41) - Wikipedia
9. Artificial Food Dyes 2010 the Center for Science in the Public Interest called for the FDA to ban the implicated food dyes. March 31st, 2011 - Response from FDA: Insufficient Evidence The committee will make “no recommendation to ban or regulate dye additives…more research is needed”.
10. Artificial Food Dyes The Next Question: Which children react?
11. Artificial Food Dyes Study tested for: ADHD associated dopaminegenetic variants Two genetic variants for impaired histamine metabolism Which genes tracked with the reaction????
12. Histamine It was the HISTAMINE!!!! Histamine is the chemical released when you have an allergic reaction. That is why you take “anti-histamines” like Benadryl or Claritin
13. Histamine WAIT – when there is food intolerance, histamine release happens in the GI tract, not the brain. True, but when the body cannot clear the histamine from the blood, it floods the brain and causes ADHD symptoms. There are at least three types of histamine receptors in the brain: H1, H2, H3. H3 receptors are the ones that cause ADHD symptoms when there is too much histamine.
14. Histamine Interesting Questions: What about all the other events that trigger histamine release? What about the people who have reactions to the foods, but can clear most of the histamine? Could adult onset allergies be the reason for adult onset ADHD? Can you treat some ADHD by OTC antihistamines?
15. Histamine So what does histamine do in the brain anyway???? Histamine (H3) receptors are EVERYWHERE !!! Histamine (H3) controls: Sleep and wakefulness Learning and memory Anxiety Locomotion Feeding and drinking Hormone regulation AND Dopamine/norepinephrine Future Medical Engineering based on Bio-nanotechnology 21st century COE Program.
16. Histamine Histamine receptors (H3) control: Sleep and wakefulness Learning and memory Anxiety Locomotion Feeding and drinking Hormone regulation Future Medical Engineering based on Bio-nanotechnology 21st century COE Program. AND Dopamine/norepinephrine
17. Histamine and Foods Wait… Isn’t histamine also in some foods???
18. Histamine and Foods YES!!!!
19. Histamine and Foods Foodsthat are high in histamine Fish, Mackerel, Herring, Sardine, Tuna, Cheese, Gouda, Camembert, Cheddar, Emmental, Swiss, Parmesan, Fermented sausage, Salami, Fermented ham, Sauerkraut, Spinach, Eggplant, Tomato ketchup, Red wine vinegar, Alcohol, White wine, Red wine, Top-fermented beer, Bottom-fermented beer, Champagne, Citrus fruit, Fish Additives, Papaya, Crustaceans, Liquorice, Strawberries, Pork Spices, Pineapple, Egg white, Nuts, Peanuts, Tomatoes, Spinach, Chocolate
20. Poison Ivy?
21. The “Chinese Herbs” Study A Compound Herbal Preparation (CHP) in the Treatment of Children With ADHD: A Randomized Controlled Trial - J Atten Disord. 2010 Nov;14(3):281-91. Epub 2010 Mar 12 Widely reported as proof herbs can treat ADHD Maybe, but this study does not answer the question It is an infomercial masquerading as research
22. The “Chinese Herbs” Study Research article did not report ANY direct measures of ADHD. According to the company website, they collected the data. Why leave data out of the report? Small improvement in TOVA (a continuous performance test used to measure attention). (Omega-3’s improve TOVA more than CHP!)
23. The “Chinese Herbs” Study Authors also claim product is “safe”, “well tolerated” and that the ingredients are approved by the FDA.
24. The “Chinese Herbs” Study Actually the most potentially toxic supplement I have ever seen: autoimmune disorders elevated blood glucose elevated cholesterol viral infection brain cancer miscarriage thyrotoxicosis or impaired thyroid liver damage decreased neuroplasticity (learning) two ingredients are potent chemotherapy agents. increased risk from anaesthesia weight gain shown to be cytotoxic and impair DNA in fish. “Natural” does NOT mean safe!!!!!
25. The “Chinese Herbs” Study: Approved by FDA? By Federal law, supplements/herbal products are food NOT medication
26. The “Chinese Herbs” Study: Approved by FDA? FDA does not Approvesupplements or herbs Insurethey are safe before being sold Require the label list known side effects or dangerous drug interactions
27. The “Chinese Herbs” Study: Approved by FDA? “FDA is responsible for taking action against any unsafe dietary supplement product after it reaches the market.”
28. The “Chinese herbs” Study: Conflict of Interest? Authors – M. Katz, A. Adar Levine, H. Kol-Degani and L. Kav-Venaki “..no conflict of interest” Look behind the curtain!
29. The “Chinese herbs” Study: Conflict of Interest? Compound Herbal Preparation is a proprietary product sold as “Nurture & Clarity” by The Tree of Healing Clinic “The Tree of Healing clinic was “established and is managed by” HadassaKol-Degani& LioraTanuryKav-Venaki
30. Stimulant Research Update Short-term Effects Benefits Enhance classroom manageability Increase attention and academic productivity Impair cognitive flexibility creativity problem solving Transitioning Executive function skills?
31. Dosing Stimulants: A Balancing Act Productivity Increasing effect of stimulant Increasing dose of stimulant
32. Dosing Stimulants: A Balancing Act Productivity Transitioning (creativity) Increasing effect of stimulant Increasing dose of stimulant
33. Dosing Stimulants: A Balancing Act Productivity Transitioning (creativity) Side effects Increasing effect of stimulant Increasing dose of stimulant
34. Dosing Stimulants: A Balancing Act Productivity Transitioning (creativity) Side effects Agitated, can’t sit still Increasing effect of stimulant Poor focus in class Increasing dose of stimulant
35. Dosing Stimulants: A Balancing Act Productivity Transitioning (creativity) Side effects Agitated, can’t sit still Increasing effect of stimulant Poor focus in class Target dose range Increasing dose of stimulant

36. Where the “U” Comes From

    Up-slope: Increased adrenaline Increasing effect of stimulant Connections between the cells open up Concentration and productivity improve Down-slope: Increasing dose of stimulant Safety valve to prevent seizures Connections between the cells close down Complete shut down = ADHD brain freeze
37. Stimulant Research Update Long-term stimulants are of very limited benefit What stimulants do not do… suspended or repeat a grade, compared with controls. By the time they reach adolescence, fail more grades have lower report card scores, lower class rankings worse scores on standardized achievement tests more years to complete high school lower rates of college attendance and graduation. normalize the ability to learn and apply knowledge. prevent academic underachievement and poor educational outcomes improve full-scale IQ improve reading and arithmetic achievement tests, decrease remedial academic services, decrease special education classes, decrease probability of repeating a grade of being expelled,
38. Special Update Amphetamines Neurotoxicity (previous talk) Epidemiology studies – Possible increased risk for Parkinson’s Disease Neurotoxicology. 2006 Dec;27(6):1003-6. Epub 2006 Mar 28. Amphetamine exposure is elevated in Parkinson's disease. Garwood ER, Bekele W, McCulloch CE, Christine CW. Mov Disord. 2010 Jan 30;25(2):228-31. Parkinsonism in patients with a history of amphetamine exposure. Christine CW, Garwood ER, Schrock LE, Austin DE, McCulloch CE.
39. Contact Information Tracy A. Ware, MD Chapel Hill Psychiatric Associates, PA 610 Jones Ferry Road Ste 208 Carrboro, NC 27510 VM: 919-338-2940 twareMD@chapelhillpa.com