Adult ADD
Attention deficit disorder (ADD) and attention deficit disorder with hyperactivity (ADHD) are estimated to affect 5% of the global population, and about 1.2% of Americans, or 2 million people. While a great deal of attention has been focused on children with ADD, 50% of those kids continue to show symptoms as adults. We’ll focus more on adult ADD, with the understanding that, for an adult, their problems started long ago in childhood.
There are two main kinds of ADD/ADHD:
1. Inattentive (ADD)
2. Hyperactive/impulsive (ADHD)
3. Combined, with features of inattentive and hyperactive.
I’ll refer to ADD and ADHD as ADHD, for the sake of simplicity. What exactly is ADHD? It is a diagnosis given to children with numerous symptoms, including: mood swings, problems completing tasks, difficulty with concentration, disorganization, restlessness, temper tantrums, impulsivity and difficulty coping with stress. With all of those symptoms, there is one overriding problem, and that is a problem focusing. ADHD is referred to as a “focus” problem. Kids with ADHD are often gifted and quite intelligent. But their gifts are not well expressed in a classroom. The general regimentation of most classrooms can drive these kids crazy. In order to understand adult ADHD, we need to look at their life experience from K through 12th grade.
These kids are “different,” which doesn’t make them bad or wrong. They just don’t fit the expected mold for kids in school. Parents who are not in favor of standard treatment of putting their kids on amphetamines (which is what Ritalin and Adderall are) have a difficult battle on their hands. Their children are usually “diagnosed” by a teacher or school official with no medical expertise. Parents are often notified by the school (not their doctor) that their child “has ADHD and needs to be put on Ritalin.” Parents who resist this diagnosis and treatment are often put under a great deal of pressure by the school.
Over the years I’ve observed that these kids with problems focusing in a classroom often have highly developed skills outside the classroom. I will include autism spectrum children in this part of the discussion. ADHD kids know they are different, distractible and often poor students. There is a lot of shame they have to bear. They suffer the blows of name-calling by other kids (like: “you’re stupid”) and the frustrated looks from teachers who may feel that the child with ADHD is making their life miserable. One adult who grew up with ADHD had great mechanical skills and a passion for cars. From an early age, in his spare time he studied cars, and by the time he graduated from high school, could take apart and repair most cars—except for our cars that are now totally computerized. One boy with moderate autism had the ability from age 5 or 6 to take apart a radio completely, and then reassemble it. While he was socially awkward, in his last year of high school he won a state science award. Many ADHD kids have special gifts, when they are learning on their own time schedule outside the structured confines of a classroom.
A number of federal agencies have staked out their particular niche in the overall ADHD power play. For example, the NIH (National Institutes of Health) states that the cause of ADHD is unknown, and they go on to state what does not cause it. “ADHD is not usually caused by too much TV, food allergies, excess sugar, poor home life, or poor schools.” The purpose of this statement is to discourage parents and doctors from looking at alternative treatments and nutritional/metabolic analysis.
Adult ADHD Symptoms
The adult with ADHD is a survivor of childhood ADHD. People with adult ADHD have trouble focusing and concentrating. They are distractible, have trouble working in a way that requires multi-tasking, are disorganized, and frequently don’t finish projects on time. Those symptoms are mainly caused by the biology of ADHD, but it’s clear that when people suffer from the cascade caused by a “focus problem,” they are likely to experience self-doubt, anxiety, and depression. Here are more things to look for if you think that you or someone close to you might have adult ADHD: An chronic anxiety, impulsive spending habits, lack of attention to detail, learning problems, trouble following the proper channels or chain of commands, frequent traffic violations, impulsive job changes, trouble maintaining an organized work and/or home environment, chronically late or always in a hurry, frequently overwhelmed by tasks of daily living, procrastination, inconsistent work performance, sense of underachievement, frequent mood swings, tendency toward being argumentative, needless worry, and having quick or exaggerated responses to real or imagined slights.
Many adults with ADHD do very well, without taking drugs like Adderal or Ritalin. They have learned how to manage their weaknesses, and maximize their strengths. They’ve learned ways of staying organized. I don’t have data about this, but some people with adult ADHD do very well when they are running the company. They may need organizational help at work, but they do much better when they can let their own motivation and creativity run the show, rather than following orders in a job that they may not be passionate about.
Diagnosing Causes of ADHD
There is no single cause that explains childhood and adult ADHD. However, the following scenario is one that alternative doctors have seen countless times. The problems that start in childhood persist in half the kids with ADHD, and the biology that started in childhood remains about the same in adult ADHD.
It all starts in the gastrointestinal tract (GI), which normally has a balance of friendly bacteria like acidophilus and bifidus, as well as a small amount of yeast. Yeast makes some of our B vitamins. The most common starting point of a GI imbalance is caused by antibiotics. Every time a child with a sore throat or ear infection is given an antibiotic, something good happens and something bad happens. The bacteria in the ear are killed off. That’s good. The friendly bacteria in the GI tract are killed off, and that is not good. Adults have between 2 and 5 pounds of intestinal bacteria, and we want them to be the good bacteria. When antibiotics kill off a large portion of friendly GI bacteria, the yeast, which was kept in check by the bacteria, can suddenly grow out of control.
Leaky Gut Syndrome
The yeast overgrowth is an infection that irritates and inflames the GI tract. The cells lining the GI tract normally create a tight barrier, keeping food and anything else contained within the GI tract from entering the blood stream. After a prolonged period of yeast overgrowth, the cells lining our GI tract loosen up, allowing undigested food particles to slip into the blood stream, creating “Leaky Gut Syndrome.” At the same time, yeast can now enter the bloodstream, leading to systemic Candida (a kind of yeast). It should be pointed out that the GI tract is our first line of immune defense, and when the process you’ve just read goes unchecked, the immunity of the GI tract goes down, and we become more susceptible to a variety of infections.
Delayed Food Allergies
There are two kinds of allergies. “Immediate” allergies, caused by foods like walnuts, shrimp, and lobster, manifest within an hour of eating that food. These allergies often produce skin rashes, hives, stomach upset, and potentially fatal conditions like anaphylactic shock.
The kind of food allergies that arise out of a leaky gut are “delayed” food allergies, which means that, after you’ve eaten an allergic food, your body won’t show the effects of that allergy for 6 to 72 hours. Let’s say that, after you’ve eaten some turkey, tiny bits of turkey slip into the blood stream. It could be any food, but let’s talk turkey here. Your immune system “sees” a tiny piece of turkey in the blood, and recognizes that it should not be in the blood. The immune system makes an antibody against turkey. That antibody binds with that tiny piece of turkey forming a “food-antibody complex.” These food-antibody complexes (FAC) are the mechanism of delayed food allergies. The FACs deposit in body tissues from head to toe, creating tiny areas of inflammation wherever they settle. The more turkey you eat, the more FACs are created, making themselves at home in muscle and body tissues.
95% of food allergies are the delayed type. The most accurate way to identify delayed food allergies is through blood testing. A variety of specialty labs run this test, which examines 90 to 100 different foods. In general, kids with ADHD have massive delayed food allergies, sometimes being allergic to 80 or more of the foods tested for. Doing this blood test and eliminating those foods that create delayed food allergies often leads to dramatic improvement in ADHD.
Candida
Yeast (Candida) overgrowth in the GI tract will almost always cause digestive problems. Systemic Candida, present throughout the body, can cause problems with memory, focus, concentration, mood, fatigue, brain fog, muscle weakness, and 50 other possible symptoms. Candida contains about 100 peptides (short strings of amino acids) that are mildly toxic to the brain. The most accurate way to diagnose Candida is through a blood test called “anti-Candida antibodies.” That test indicates if there is GI overgrowth of Candida, systemic overgrowth, or both. It also gives a numerical value so we know how severe the overgrowth is.
Candida requires its own article, but let me briefly summarize the treatment steps:
- If it is systemic, use a drug, like ketaconozole. Herbs do not do a good job of killing yeast outside the GI tract. If the Candida is limited to the GI tract, a number of herbs can be used, including: oil of oregano and olive leaf extract.
- Take probiotics, the friendly GI bacteria.
- The amino acid l-glutamine is like food for the cells lining the GI tract. They soak up glutamine, helping to cure leaky gut syndrome.
- Begin a diet that eliminates sugar, sweets, and fermented foods for 3 to 6 months.
By diagnosing and treating Candida, leaky gut syndrome, and delayed food allergies, we can make a huge improvement in ADHD — whether the patient is an adult or a child. There are other issues to look for, such as mercury or other chemical toxicity, and undiagnosed inflammation.
Brain Chemistry
It is not known how Candida, leaky gut, and delayed food allergies cause ADHD, but ultimately we have to look at changes in brain chemistry. The main symptom of attention deficit disorder in adults is difficulty with the brain activity responsible for monitoring a person’s own behavior. This causes one of the biggest problems adults with ADD face, which is developing a sense of self-regulation.
In an article August 8, 2007 in Scientific Daily, scientists suggested that ADHD may be the result of reduced dopamine levels in the brain. Dopamine plays important roles in behavior and thinking, attention, learning, motor activity, motivation, sleep, and mood. It’s also a “feel-good” neurotransmitter.
The dopamine receptor site is where Ritalin, Adderall and all amphetamines work. Nutritional tests (like amino acid testing and urine organic acids) can show whether a person has a problem with dopamine, norepinephrine, and/or serotonin. With that information, we can develop more targeted, and more natural treatment approaches.
The adult with ADHD has a number of infectious and metabolic problems that we can test for and treat. If all else fails, medications like Adderall and Ritalin can be used, but I suggest them as the last resort and not the first.
David Gersten, M.D. practices Nutritional Medicine and Integrative Psychiatry out of his Encinitas office and can be reached at 760-633-3063. Please feel free to access 1,000 on-line pages about holistic health, amino acids, and nutritional therapy at www.aminoacidpower.com and www.imagerynet.com.