Attention Deficit Hyperactivity Disorder Conference
Dr. Lieberman’s note: The following is my report on a meeting I attended that was sponsored by Georgetown University, the International Center for Interdisciplinary Studies of Immunology, and the International Health Foundation. It is regrettable that although these findings were reported nearly a decade ago (in 1999), very few doctors or parents today understand that there really are effective alternatives to drugs for children with ADHD.
This meeting was a breath of fresh air as leaders were chosen for their ability to present new and old, yet more unaccepted, ideas on the causes of this ever-growing problem seen in children. In California the data shows a greater than 2000% increase in ADHD. This figure stresses the importance of this problem. Although genetics play an important role in the cause of ADHD, environmental factors are also important in its expression and it’s here that I was especially interested.
One very important paper was that of Drs. Bellanti and Sabri who showed that the presence of patches of lymphoid hyperplasia in the ileum or small bowel of these children was identical to that reported by Andrew Wakefield of England in children with Autism. Dr. Sabri said it mirrored that of Crohn’s Disease or inflammation disease of bowel.
Their studies showed also a decrease in the cytokines IL-2 and interferon gamma. The importance here was that this set the immune system up for T-Helper 1 cytokine deficiency pattern also seen in celiac disease and food allergy of non-IgE origin. All of their children had ADHD.
What researchers are finding and reporting in 1999 only supports what older physicians and members of the American Academy of Environmental Medicine have been saying for years — food sensitivity is a major factor in the behavior and learning of not only children but adults as well. Billy Crook, one of the co-sponsors of the meeting and author of several books on the role of yeast in the cause of behavior and learning problems, was finally vindicated.
The mechanism for all this does appear to come from the massive use of antibiotics in early childhood, which alters the normal bacterial flora and allows for a super abundance of yeast and pathogenic bacteria to predominate. This dysbiosis or floral imbalance creates increased permeability of the gut allowing food in larger and more allergy-provoking form to enter the blood stream.
An incidental, though pertinent, paper was sited by Wickens, K., Clinical Experience in Allergy 1999; 29:766-771 showing that the greater the number of antibiotics given in the first year of life, the greater the risk ratio for onset of asthma and hay fever later in life. What is becoming much more obvious though certainly not expected is the overt relationship between the gut and the brain. The pieces of the puzzle now fall together and explain what was obvious to physicians of open minds — food sensitivities can alter brain function, affecting thinking, perception, mood, and behavior. Those foods that were most frequently eaten were also the ones causing adverse reactions. These included milk, wheat, corn, cane sugar, etc. Randolph taught years ago that food addiction was food allergy and vice versa. Additives, also, are more commonly associated with adverse reactions.
Michael Jacob Ph.D. presented his paper on food, food additives and behavior recommending that parents consider dietary changes (along with behavior therapy) as the first treatment for children with behavior problems, before turning to drugs. We here at the Center for Occupational & Environmental Medicine strongly agree because in our experience food has always been the most common cause of adverse reactions, though certainly not the only factor.
The presentation by Steven Schoenthaler added more fuel to the fire in demonstrating the role of inadequate nutrition on behavior. His studies were done on inmates of prisons and juvenile delinquency programs. When fresh fruits, vegetables and supplementary vitamins and minerals were added to diets of the prisons there was significant reduction in bad behavior. Of interest also was an increase of 16 points in I.Q. on average in this population.
Marvin Boris presented a short but important review of the literature on: Food and Chemical Intolerance – Placebo controlled studies in ADD. He pointed out that despite many scientific articles showing a clear relationship between the Attention Deficit Disorders with foods, artificial colors and additives, many professional health organizations have denied the existence of any association. He cited 26 references which are included here as a useful reference. In 7 controlled studies (19-26) results were positive. Blinded challenges, crossover protocols were highly statistically significant in over 390 children with ADD.
It was good to hear our friend Nicholas Ashford of M.I.T. review the importance of toxic chemical exposures, especially low level exposures to adverse biological effects including endocrine disruption, chemical sensitivity and cancer. There is hardly a day that we don’t observe the effects of low dose chemical exposure in patients that we see at our Center.
The presentation by John Wargo on childhood exposure to pesticides affecting the nervous system only re-enforced what our Center has been saying for years. The Government has allowed 8627 additives to our food, with 1800 pesticides and inert ingredients to remain as residues within the nation’s food supply. Wargo stressed the vulnerability of a fetus and growing children to these chemicals. People interested in learning more can read his book: J. Wargo, Our Children’s Toxic Legacy: How Science And Law Fail To Protect Us From Pesticides. Yale University Press 2nd edition.
Theo Colborn then spoke on effects of chemicals but especially of organochlorines. She makes the comment that, ” …everyone will have more than 500 measurable chemicals in his or her body, many of which will be organochlorines”. She was especially alarmed at the finding that biologists cannot find a top predator fish in the Great Lakes that does not have enlarged thyroid glands and abnormal ratios of T4, T3 and TSH. She paralleled the poisoning of the thyroid in fish with that of a developing fetus. The brain’s development is dependent on thyroid hormone as is the ear’s cochlea. Without the hormone, low frequency hearing loss occurs along with motor incoordination. The interference from organochlorines polluting our environment, she warned, was interfering with the fetus and child’s development. Ironically, she was basing her warning on animal models. However, PCBs have been reported to injure the brains of babies born to mothers exposed to PCBs.
Colborn concluded with, “… it’s time to practice prevention and focus more on the development of our children while they are in the womb, keeping in mind that damage to the brain during development is irreversible, intractable, and untreatable.” Readers wishing to learn more about Colborn’s research may want to read her book Our Stolen Future.
The “piece de resistance” of the two and a half day meeting, for me, was hearing my old friends and teachers Drs. Sidney Baker and Bill Crook. Dr. Baker had the ability to make the most complicated subject understandable and he did it again with his talk – ADHD in the Nosologic Tree: A clinician’s view from the end of the limb. I often quote Dr. Sidney with his simple paradigm that most patients may have a need for something (a deficiency) or a need to avoid something (an allergic or toxic substance or an infectious disorder).
To sum up his experience, which is certainly similar to mine, he concludes that the most common biomedical solutions to the ADHD problem are:
- avoidance of delayed reaction food allergens.
- treatment of fungal overgrowth consequent to use of antibacterial agents, and
- correction of deficiencies or special needs for magnesium and essential fatty acids.
The highlight of the meeting was the standing ovation given to 82 year old Dr. Billy Crook , author and teacher, who over the last 15 years pushed the hypothesis that yeast secondary to antibiotic use was at the heart of so many health problems, including ADHD. It took many sophisticated lab tests that we can now do to finally vindicate this great clinician. I was very happy to have attended and participated from the floor of this outstanding conference.
The establishment of the Center for Occupational & Environmental Medicine grew out of my years of experience treating ADHD children. I saw a need for a different approach than the established use of stimulant drugs. This led me to the American Academy of Environmental Medicine and the teachings of Dr. Billy Crook, Dr. Joseph Miller, Dr. Theron Randolph, Dr. Doris Rapp, and the many others who taught me the basics of allergy, nutrition and toxicology. At the Center for Occupational & Environmental Medicine, we have been able to effectively treat many children with these disorders, but instead of using stimulant medication, we identify and treat the cause.
Summary of the Fifth International Meeting of the British Society of Allergy, Environmental Medicine and Nutrition, Sustainable Medicine
Oxford University, England, Sept 7-10, 1998.