You know a health condition has become mainstream when its acronym is used as an adjective in our daily lexicon. These days, joking that you are feeling "very ADHD" is practically interchangeable with saying you feel scattered or unfocused. And although most of us don't actually have the condition, an estimated 4 percent of adults and 3 percent to 5 percent of children do.

In 1998, a research panel at the National Institutes of Health concluded attention deficit-hyperactivity disorder is indeed real, but since then, the NIH has not been able to conclusively state much about the causes of the disorder. What is becoming clear, however, is that a number of clinical studies have begun to back up the idea that dietary factors and nutritional deficiencies may play a major role in the development of ADHD. Here is a sampling of supplements whose power to ease ADHD symptoms are backed by science, as well as a sidebar (see "Disruptive Diet" on next page) that touches on the link between food and ADHD.

ADHD is a neurobiological and behavioral disorder that can occur in children, adolescents or adults. The acronym ADHD serves as an umbrella term for a continuum of disorders, ranging from general inattentiveness (previously referred to as attention deficit disorder, or ADD) to hyperactivity to a combination of the two. People affected by ADHD generally have difficulty paying attention, concentrating, remembering and staying organized. Some children and adults with the condition also suffer from hyperactivity, aggressiveness and relationship problems.

Conventional treatment for the condition generally includes behavioral and cognitive therapies along with the use of stimulant drugs such as Ritalin, dexedrine, Adderall and Cylert. Scientists are not exactly sure how these drugs work, but most now believe that they stimulate receptors in the frontal lobes of the brain that allow people to filter out various stimuli instead of reacting ceaselessly to each one. But such results come at a cost. Side effects can include depression, headache, suppressed appetite, elevated blood pressure, growth impairment, insomnia and stomachache. Using nutritional supplements to treat ADHD appears to offer a gentler option, but how well do they work? Take a look at a few of the top contenders.

Essential fatty acids
Major changes in the American diet over the last century have created a significant deficiency of omega-3 essential fatty acids and an excess of omega-6 fatty acids in foods. What's more, research has shown that kids with ADHD may be particularly deficient in EFAs necessary for normal brain function. Therefore, it is possible that taking supplemental EFAs may help correct an underlying deficiency in these nutrients, thereby restoring normal levels in the brain. Another possibility is that children with ADHD have an unusually high requirement for EFAs that cannot be met by a typical American diet.

In one study, 41 children ages 8 to 12 with specific learning difficulties and higher than average ADHD symptom ratings were randomly assigned to receive either a combination of EFAs (186 mg eicosapentaenoic acid, 486 mg docosahexaenoic acid, 96 mg linolenic acid) or placebo for 12 weeks.¹ At the beginning of the study and at follow-up, a range of behavioral and learning problems associated with ADHD was assessed by parents using standardized rating scales. After 12 weeks, mean scores for cognitive problems and general behavior problems were significantly lower for the EFA group than the placebo group.

In a preliminary trial, 30 adults with ADHD were randomly assigned to 12 weeks of supplementation with olive oil (which contains less than 1 percent omega-3 fatty acids), flax oil (a good source of alpha-linolenic acid) or fish oil (high in both EPA and DHA).2 Blood levels of fatty acids were measured at the start of the trial and again after 12 weeks. While flax oil supplementation resulted in an increase in ALA and a slight decrease in the ratio of omega-6 to omega-3 fatty acids, fish oil supplementation brought about significant increases in EPA, DHA and total omega-3 fatty acids, as well as a decrease in the ratio of omega-6 to omega-3. This suggests that fish oil may be more effective in improving fatty acid profiles and therefore alleviating the symptoms of ADHD.

Magnesium
Magnesium is an essential mineral, needed by the body to form bone and protein, relax muscles, generate energy and secrete insulin. Magnesium deficiency also appears to play a role in ADHD. In one investigation of 116 children diagnosed with ADHD (94 boys and 20 girls ages 9 to 12), magnesium levels were determined via blood serum, red blood cells and hair with the aid of atomic absorption spectroscopy. Magnesium deficiency was found in 95 percent of those examined.3 Furthermore, in a controlled trial involving children with ADHD whose blood and hair revealed low magnesium levels, 50 were given 200 mg of magnesium per day for six months, and 25 were given placebo.4 Results showed the children given magnesium had a significant decrease in hyperactive behavior.

Zinc
Insufficient levels of zinc also appear to play a part in the development of ADHD. As an essential mineral, zinc is necessary to help the body heal wounds, boost immunity, protect against free radical damage and synthesize protein. In a double-blind study, 44 children diagnosed with ADHD (26 boys and 18 girls between the ages of 5 and 11) were randomly assigned to receive either 15 mg zinc sulphate or placebo for six weeks.5 Those children taking zinc showed significantly greater behavioral improvement, compared with children who received the placebo. Although the mechanism by which they work is not completely clear, scientists believe zinc supplements may help to regulate the function of the neurotransmitter dopamine, which is thought to play a role in ADHD.

In a similar study, 400 children with ADHD (72 girls and 328 boys) were randomly assigned to receive either 150 mg zinc sulfate or placebo each day for 12 weeks.6 Results showed zinc was statistically superior to placebo in reducing symptoms of hyperactivity, impulsiveness and impaired socialization, but not in reducing attention deficiency symptoms. Zinc sulfate was well tolerated and associated with a low rate of side effects.

L-carnitine
Created in the body from the amino acids lysine and methionine, L-carnitine is required for the body to release energy from stored fat. While it is not known how L-carnitine improves behavior in children with ADHD, low blood levels of L-carnitine have been detected in some of these children, and supplementation may help.

In a small, double-blind study, 13 out of 23 boys with ADHD randomly received 100 mg per 2.2 pounds of body weight per day of L-carnitine for eight weeks, while the rest received placebo.7 Those taking L-carnitine showed marked improvement in both home and school behavior. No adverse effects were seen, although the safety of long-term L-carnitine supplementation in children has not been well studied.

American ginseng and gingko biloba
While it is still too early to conclude that American ginseng (Panax quinquefolius) and ginkgo biloba improve the symptoms of ADHD, a recent study suggests they may.8 In the preliminary trial, 36 children diagnosed with ADHD, ranging in age from 3 to 17, were given capsules containing 200 mg ginseng and 50 mg ginkgo twice daily on an empty stomach for four weeks. The children's parents assessed their behavior after two and four weeks. Results showed behavior improved and hyperactivity decreased with the herbal combination. It is important to keep in mind that this study had methodological shortcomings, including the fact that it was not placebo controlled, and that additional studies to confirm these findings have not been conducted. However, the trial's results are intriguing, and suggest further research should be performed.

Homeopathy
A recent double-blind, placebo-controlled crossover study suggests homeopathy has promise for addressing ADHD symptoms.9 In the trial, 83 children diagnosed with ADHD, ages 6 to 16, were treated with individually prescribed homeopathic remedies. (Homeopathic practitioners believe homeopathy is most effective when remedies are prescribed on a case-by-case basis, as opposed to a one-size-fits-all approach.) The 62 participants who showed at least a 50 percent improvement in symptoms, based on the Conners' Global Index (a standardized measure of cognitive and behavioral symptoms), were selected for inclusion in the study.

The participants were then split into two groups and randomly assigned to receive the homeopathic remedy for six weeks followed by placebo for six weeks, or vice versa; the two groups were then switched. At the beginning of the trial and at the end of each crossover period, parents evaluated their children's behavior and the children underwent neuropsychological testing. Parents rated their children as significantly better behaved when they were taking the homeopathic remedy than when they received the placebo. The cognitive and behavioral testing also suggested that homeopathy is effective in treating ADHD symptoms.

Based on studies to date, it seems the scientific community is only beginning to uncover the power of natural remedies to prevent and treat ADHD. It appears that natural treatments such as ginkgo, ginseng, L-carnitine and homeopathy may hold potential for the safe treatment of ADHD. But until more science accrues, steer your customers to those supplements whose power to help with this condition is better established, such as essential fatty acids, magnesium and zinc.

Linda Knittel is a Portland, Ore.-based freelance writer. She is the author of User's Guide to Natural Remedies for Depression (Basic Health Publications, 2003).

References
1. Richardson AJ, Puri BK. A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties. Prog Neuropsychopharmacol Biol Psychiatry 2002;26:233?9.
2. Young GS, et al. Effect of randomized supplementation with high dose olive, flax or fish oil on serum phospholipid fatty acid levels in adults with attention deficit hyperactivity disorder. Reprod Nutr Dev 2005 Sept-Oct;45(5):549?58.
3. Kozielec T, Starobrat-Hermelin B. Assessment of magnesium levels in children with attention deficit hyperactivity disorder (ADHD). Magnes Res 1997;10(2):143?8.
4. Starobrat-Hermelin B, Kozielec T. The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactivity disorder (ADHD). Positive response to magnesium oral loading test. Magnes Res 1997;10:149?56.
5. Akhondzadeh S, et al. Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children: a double blind and randomized trial. BMC Psychiatry 2004;4:9.
6. Bilici M, et al. Double-blind, placebo-controlled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2004;28(1):181?90.
7. Lyon MR, et al. Effect of the herbal extract combination Panax quinquefolium and Ginkgo biloba on attention-deficit hyperactivity disorder: a pilot study. J Psychiatry Neurosci 2001;26(3):221?8.
8. Van Oudheusden LJ, Scholte HR. Efficacy of carnitine in the treatment of children with attention-deficit hyperactivity disorder. Prostaglandins Leukot Essent Fatty Acids 2002;67(1):33?8.
9. Frei H, et al. Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomized, double blind, placebo controlled crossover trial. Eur J Pediatr 2005;164(12):758?67.
10. Bateman B, et al. The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Arch Dis Child 2005;90(8):875.

Natural Foods Merchandiser volume XXVII/number 10/p. 108-109, 112