Welcome to another edition of Common Ground Online. Here's what's in this week's edition:
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Julia J. Rucklidge, PhD,
Department of Psychology,
University of Canterbury,
New Zealand |
Researchers Julia J. Rucklidge and Jeanette Johnstone from the University of Canterbury, New Zealand, along with Bonnie J. Kaplan from the University of Calgary, Canada, recently published a review article in Expert Review of Neurotherapeutics.
EMPowerplus is specifically mentioned in their discussion of multinutrient interventions used to mitigate the symptoms of ADHD. They call multi-ingredient approaches “an intriguing yet under-researched area”. They compare the research done on individual vitamins and minerals to multinutrient approaches, and explain some of the possible reasons why broad-spectrum approaches (like EMPowerplus) have a greater effect on the body than single vitamins or minerals.
Below are a few quotes from their article:
Overview of ADHD
"Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders, characterized by problems with inattention, hyperactivity and impulsivity. It is now accepted that ADHD can be a chronic condition across the lifespan. Worldwide prevalence rates are estimated at 5.29% and it is now believed that as many as 4–5% of adults may suffer from ADHD. The disorder is more commonly diagnosed in boys, with male-to-female ratios estimated at 2:1 – 9:1. Overall, it is viewed as treatable but not curable…
"Stimulant medications, such as methylphenidate (ritalin™), pemoline (cylert™) and dextroamphetamine (dexedrine™), with or without cognitive–behavioral therapy, are the most common and most studied treatments for childhood ADHD. However, despite modern psychopharmacological advances, only 30–70% of adults with ADHD respond to these types of interventions, a rate lower than that observed in ADHD children. Additionally, many trials exclude patients with co-occurring disorders, so even less is known about medication treatment in these individuals. These limitations make it difficult to establish who would benefit from drug treatment given that trial participants are often quite different from those seen in the community. Side effects associated with pharmacological treatments for ADHD can also be concerning, as they include cardiovascular risks (methylphenidate) and suicide attempts (FDA warning on Strattera/atomoxetine)."
Alternative treatments
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Bonnie J. Kaplan, PhD,
Professor, Departments of Paediatrics and
Community Health Sciences, University of Calgary,
Behavioural Research Unit,
Alberta Children’s Hospital
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"Complementary and alternative methods (CAM) for treating ADHD are often sought by families wanting treatments with fewer side effects or remedies they consider ‘safer’ than medication. It is important for clinicians to ask patients and their families whether they are using any supplements, given that these can influence medication treatment. Bussing et al. found, in a sample of 822 families, that 12% of children diagnosed with ADHD used CAM, and 7% of parents who suspected ADHD in their child used them. Other studies confirm the high rate of CAM use with children and lack of disclosure to medical practitioners. Stubberfield and colleagues found that 65% of their sample of children with ADHD were using some form of alternative therapy.
"Psychiatry has been slow to embrace nutritional approaches to ADHD, despite a wealth of data showing that children are not receiving the recommended daily allowances of nutrients. The negative studies on megavitamins have not assisted the field in moving forward to investigate such treatments. Although there is much research on medication, there has been very little on nutrient interventions, which is probably partially attributable to the fact that funds are rarely available for that type of study. The lack of scientific data makes treatment decisions difficult for families, who may then resort to trial and error. More concerning, is that families often do not inform their medical practitioners of alternative treatments being used, placing children at unnecessary risk from potential interactions between conventional treatments and alternatives."
Multinutrient interventions
"In contrast to the mixed evidence on single nutrients, the very recent data on multinutrient supplementation appears to be more consistently positive as an approach but more research is needed, particularly RCTs [Randomized Controlled Trials]. As ADHD is a complex disorder, with heterogeneous symptoms, it is not surprising that a multi-ingredient supplementation might be required for benefit. However, the data are sparse as this area of study is in its infancy.
"Most scientific methodology alters a single variable at a time, so it is worth briefly considering the justification for multinutrient supplementation. Every neurotransmitter goes through many metabolic steps to ensure its synthesis, uptake and breakdown. Every one of those steps requires enzymes, and every enzyme is dependent upon multiple coenzymes (cofactors). A variety of vitamins and minerals are required as cofactors in most, if not all, of those steps. Consequently, as discussed elsewhere, one possible mechanism underlying psychiatric symptoms is inborn metabolic dysfunction associated with slowed metabolic activity due to suboptimal availability of vitamin and mineral cofactors. Impaired brain metabolic activity associated with other disorders has already been shown to be correctable through nutrient supplementation. One can thus envision multinutrient supplementation as providing sufficient cofactor that even enzymes with drastically reduced activity become so supersaturated that near normal function is restored."
Rucklidge, JJ; Johnstone, J; Kaplan, BJ. Nutrient supplementation approaches in the treatment of ADHD. Expert Rev Neurother. 2009 Apr;9(4):461-76.
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