How Food Sensitivities Can Negatively Affect Children with ADHD

Our take:

“Food sensitivities do not just affect the digestive system. When we eat foods that our body does not agree with, it can lead to neurological problems such as hyperactivity, acting out and the inability to pay attention. The following is a recent research article the shows this relationship. The important thing to remember is that these food sensitivities can be reversed with proper treatment.”

Effects of a Restricted Elimination Diet on the Behaviour of Children with ADHD

 

Background

The effects of a restricted elimination diet in children with attention-deficit hyperactivity disorder (ADHD) have mainly been investigated in selected subgroups of patients. We aimed to investigate whether there is a connection between diet and behaviour in an unselected group of children.

Methods

The Impact of Nutrition on Children with ADHD (INCA) study was a randomised controlled trial that consisted of an open-label phase with masked measurements followed by a double-blind crossover phase. Patients in the Netherlands and Belgium were enrolled via announcements in medical health centres and through media announcements. Randomisation in both phases was individually done by random sampling. In the open-label phase (first phase), children aged 4—8 years who were diagnosed with ADHD were randomly assigned to 5 weeks of a restricted elimination diet (diet group) or to instructions for a healthy diet (control group). Thereafter, the clinical responders (those with an improvement of at least 40% on the ADHD rating scale [ARS]) from the diet group proceeded with a 4-week double-blind crossover food challenge phase (second phase), in which high-IgG or low-IgG foods (classified on the basis of every child’s individual IgG blood test results) were added to the diet. During the first phase, only the assessing paediatrician was masked to group allocation. During the second phase (challenge phase), all persons involved were masked to challenge allocation. Primary endpoints were the change in ARS score between baseline and the end of the first phase (masked paediatrician) and between the end of the first phase and the second phase (double-blind), and the abbreviated Conners’ scale (ACS) score (unmasked) between the same timepoints. Secondary endpoints included food-specific IgG levels at baseline related to the behaviour of the diet group responders after IgG-based food challenges. The primary analyses were intention to treat for the first phase and per protocol for the second phase. INCA is registered as an International Standard Randomised Controlled Trial, number ISRCTN 76063113.

Findings

Between Nov 4, 2008, and Sept 29, 2009, 100 children were enrolled and randomly assigned to the control group (n=50) or the diet group (n=50). Between baseline and the end of the first phase, the difference between the diet group and the control group in the mean ARS total score was 23·7 (95% CI 18·6—28·8; p<0·0001) according to the masked ratings. The difference between groups in the mean ACS score between the same timepoints was 11·8 (95% CI 9·2—14·5; p<0·0001). The ARS total score increased in clinical responders after the challenge by 20·8 (95% CI 14·3—27·3; p<0·0001) and the ACS score increased by 11·6 (7·7—15·4; p<0·0001). In the challenge phase, after challenges with either high-IgG or low-IgG foods, relapse of ADHD symptoms occurred in 19 of 30 (63%) children, independent of the IgG blood levels. There were no harms or adverse events reported in both phases.

Interpretation

A strictly supervised restricted elimination diet is a valuable instrument to assess whether ADHD is induced by food. The prescription of diets on the basis of IgG blood tests should be discouraged.

Foundation of Child and Behaviour, Foundation Nuts Ohra, Foundation for Children’s Welfare Stamps Netherlands, and the KF Hein Foundation.

SOURCES:

The Lancet, Volume 377, Issue 9764, Pages 494 – 503, 5 February 2011

Dr Lidy M Pelsser MSc , Klaas Frankena PhD, Jan Toorman MD, Prof Huub F Savelkoul PhD , Prof Anthony E Dubois MD, Rob Rodrigues Pereira MD, Ton A Haagen MD, Nanda N Rommelse PhD, Prof Jan K Buitelaar MD

Low Iron Levels May Increase Blood Clot Risk

Our take:

“Ironically, in many of our most iron and ferritin deficient patients, we also find elevated levels of hsCRP. This makes the case that investigating the causal link between inflammation and iron deficiency holds to thrombosis. Another frequent clinical observation is that infectious titers with EBV, CMV, HHV6, Mycoplasma and Chlamydia pneumoniae species are often elevated in the presence of severe iron deficiency [anemia]. These organisms are known to contribute to coagulopathies and blood vessel and heart disease. Low stomach acid/digestive function is also frequently finding in patients who are low on iron. The astute clinician should investigate patients dietary intake of iron rich foods, the digestive process and through testing other minerals, assess if absorption is affected. Zinc and magnesium deficiency frequently accompanies iron deficiency in our patient population, significantly affecting energy production and stamina, stomach acid production and immune function amongst many other important core functions. We recommend testing to understand the whole causal picture as best we can construct it.”

 

Next step is determining if treating iron deficiency wards off dangerous clots

By Robert Preidt

Low levels of iron in the blood are associated with an increased risk of dangerous blood clots that form in a vein, according to the results of a new study that included patients with an inherited blood vessel disease.

The findings suggest that treating iron deficiency may help prevent the condition known as deep vein thrombosis (DVT), according to the researchers at Imperial College London in England.

DVT typically occurs in the legs and can cause pain and swelling, and can be fatal if a blood clot dislodges and travels into the blood vessels of the lungs. Major surgery, immobility and cancer are recognized risk factors for blood clots, but there is no clear cause in many cases.

The new study included 609 patients with hereditary hemorrhagic telangiectasia (HHT), a genetic disease of the blood vessels that causes excessive bleeding from the nose and gut. Many HHT patients have low iron levels due to the loss of iron through bleeding.

Patients in the study with low iron levels were at increased risk for blood clots, but those who took iron supplements did not have a higher risk. This suggests that treating iron deficiency may help prevent DVT in the general population, the researchers said in a news release from the college.

“Our study shows that in people with HHT, low levels of iron in the blood is a potentially treatable risk factor for blood clots,” lead author Dr. Claire Shovlin, from the National Heart and Lung Institute at Imperial College London and an honorary consultant at Imperial College Healthcare NHS Trust, said in the news release.

“There are small studies in the general population which would support these findings, but more studies are needed to confirm this. If the finding does apply to the general population, it would have important implications in almost every area of medicine,” Shovlin added.

The study is published in the Dec. 14 issue of the journal Thorax.

About one billion people worldwide are believed to have iron deficiency anemia, according to the researchers.

SOURCE:

Imperial College London, news release, Dec. 14, 2011

 

CPAP Benefits

Our take:

“This is a very good article describing the importance of diagnosing apnea and correcting it through appropriate interventions by a sleep specialist. Airway devices are sometimes helpful for the very mild forms of apnea, though we’ve seen incredible improvements in our Fibromyalgia Syndrome FMS and Chronic Fatigue Immune Dysfunction Syndrome CFIDS patients after Obstructive Sleep Apnea OSA has been appropriately been diagnosed and corrected.

We’ve seen in practice, as the study below indicates, that energy levels, concentration, sense of well being, blood pressure, weight and body composition improves after appropriate correction of OSA. The opposite is also true, in patients that did not have their sleep apnea corrected, treatments for their chronic degenerative conditions were not as effective as patients who experienced restorative sleep with adequate oxygenation.”

 

CPAP During Sleep Improved Blood Pressure, Cholesterol, Blood Sugar, Waist Size

Along with helping people with obstructive sleep apnea get a better night’s sleep, machines that help keep the airways open during sleep can also help improve the symptoms of metabolic syndrome, according to new research.

Metabolic syndrome is a group of symptoms that indicate a higher risk of heart disease. These symptoms include excess weight, especially in the abdomen, high blood pressure, abnormal cholesterol levels, higher blood sugar levels and insulin resistance. Many people with obstructive sleep apnea also have metabolic syndrome, according to the study.

After three months of continuous positive airway pressure (CPAP) treatment, study participants with obstructive sleep apnea and metabolic syndrome had improvements in their blood pressure, cholesterol, and blood sugar levels. Thirteen percent of those who received the breathing treatment had such significant reductions in their symptoms that they no longer qualified as having metabolic syndrome after three months of therapy.

“Patients with obstructive sleep apnea should be actively screened for metabolic syndrome or constituents of metabolic syndrome, and, in addition to lifestyle modification, weight reduction and dietary modification, [should be given] proper counseling for CPAP use, and a CPAP machine should be used regularly,” said the study’s lead author, Dr. Surendra Sharma, a professor and head of the department of internal medicine at the All India Institute of Medical Sciences in New Delhi, India.

Results of the study are published in the Dec. 15 issue of the New England Journal of Medicine. Funding for the study was provided by a grant from Pfizer. Sharma said that Pfizer does not produce CPAP machines, and they were not involved in the study’s design, implementation or interpretation.

Obstructive sleep apnea occurs when the airways close during sleep, causing a lack of oxygen that startles the person awake momentarily, though they may not be aware of awakening. This can happen several times to 100 times an hour, according to the U.S. National Heart, Lung, and Blood Institute.

The current study included 86 adults between the ages of 30 and 65. All had obstructive sleep apnea, but none was being treated with CPAP. Eighty-seven percent also had metabolic syndrome.

The study volunteers were randomly assigned to receive CPAP or sham CPAP treatment for three months. CPAP treatment involves wearing a face mask during sleep that continuously delivers air into the airway so it remains open. The sham CPAP had modifications to reduce the airflow, and the mask used had tiny holes that allowed extra air to escape. The modifications were done in such a way that even the researchers couldn’t tell who was receiving standard CPAP and who received the sham treatment.

After three months, the study volunteers went one month without treatment, and then switched groups for another three months of therapy with the opposite treatment.

Compared to the sham treatment, people treated with CPAP had an overall drop of 3.9 mm Hg systolic (the top number) blood pressure and 2.5 mm Hg diastolic blood pressure. Total cholesterol levels went down 13.3 milligrams per deciliter (mg/dL), and LDL cholesterol, the bad type, dropped by 9.6 mg/dL in the treatment group. Levels of triglyceride, another important and potentially harmful blood fat, went down by 18.7 mg/dL in those who received treatment, according to the study.

Blood sugar levels went down slightly, as did waist circumference, according to the study.

Eleven patients (13 percent) no longer qualified as having metabolic syndrome after receiving CPAP, compared with just 1 percent receiving sham CPAP.

Sharma said these positive effects likely come from the restoration of normal oxygen levels. When the body becomes oxygen-deprived in obstructive sleep apnea, it causes the body to become distressed, which causes the release of hormones that can cause cell damage that may lead to metabolic syndrome, according to Sharma.

“This study adds to the growing body of knowledge that obstructive sleep apnea has long-term consequences for your health, and that treatment reverses some of those consequences,” said Dr. David Rapoport, an associate professor of medicine and director of the Sleep Disorders Program at NYU Langone Medical Center in New York City.

Rapoport said it wasn’t clear from this study if any of the benefits seen came solely from weight loss in those on CPAP and weight gain for those on sham treatment.

“This study is thought-provoking and could be really wonderful news that using a breathing machine could have all of these beneficial effects. But, ultimately, we’d want to see clinical end points, such as the incidence of cardiovascular deaths, in order to know if an intervention is appropriate and helpful,” said Dr. Tara Narula, a cardiologist at Lenox Hill Hospital in New York City.

SOURCES:

Surendra K. Sharma, M.D., Ph.D., professor, and head, internal medicine, All India Institute of Medical Sciences, New Delhi, India; David Rapoport, M.D., associate professor of medicine, and director, Sleep Disorders Program, NYU Langone Medical Center, New York City; Tara Narula, M.D., cardiologist, Lenox Hill Hospital, New York City; Dec. 15, 2011, New England Journal of Medicine

HealthDay

‘Love Hormone’ May Buffer Kids From Mom’s Depression

Our take:

“Oxytocin is a safe and effective treatment for numerous disorders including autism and ADHD. We find that it can solidify the bond between parents and children and bring increased communication and sense of wellbeing to your child.”

 

Anxiety, Conduct Disorders More Prevalent in Children with Low Oxytocin Levels

By Robert Preidt

FRIDAY, Dec. 9 (HealthDay News) — Children born to mothers with postpartum depression are at increased risk for mental health problems, but a hormone called oxytocin may reduce the risk, according to a new study.

Oxytocin, which is produced naturally in the body and has been associated with feelings of love and trust, may help protect kids from the negative effects of maternal depression, the researchers found. A synthetic version of the hormone is available as medication.

In the study, Israeli researchers looked at 155 mother-child pairs. By the time they were 6 years old, 60 percent of children born to mothers who were consistently depressed for the first year after giving birth had mental health problems, mainly anxiety and conduct disorders.

Among the 6-year-old children whose mothers did not have postpartum depression, only 15 percent had mental health problems, the investigators noted.

The study also found that children born to mothers with extended postpartum depression were less verbal and had lower levels of playfulness and creativity, less engagement with their mothers, diminished social involvement, and less empathy for the pain and distress of others.

These children and their mothers also had disordered functioning of the oxytocin system, as shown by lower levels of oxytocin in their saliva and a variant on the oxytocin receptor gene that increases the risk of depression, according to study leader Ruth Feldman, a professor in the psychology department and the Gonda Brain Sciences Center at Bar-Ilan University, and colleagues.

Among the children born to depressed mothers, the 40 percent who did not have mental disorders by age 6 had normal functioning of the oxytocin system and normal levels of oxytocin in their saliva.

The study was slated for presentation Thursday at the annual meeting of the American College of Neuropsychopharmacology, in Hawaii.

“We found the functioning of the oxytocin system helps to safeguard some children against the effects of chronic maternal depression,” Feldman said in a college news release. “This study could lead to potential treatment options for postpartum depression and methods to help children develop stronger oxytocin systems.”

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

SOURCE:

American College of Neuropsychopharmacology, news release, Dec. 8, 2011