We continue our look over recent months at major health problems affecting our young people. Nutritional toxicologist Dr Peter Dingle examines the complex and troubling spectrum of Attention Deficit Disorders.

Attention Deficit Disorder (ADD) and Attention Deficit Hyperactive Disorder (ADHD) are neurological disorders that affect mainly young children.

Children are classified as ADD when they show signs of inattention, such as a lack of close attention to detail, difficulty in sustaining attention or are easily distracted. Some children may be underactive (hypoactive), inflexible, suffer from speech disorders and have poor short-term memory, and show sleep and appetite changes. ADHD has the added signs of hyperactivity such as fidgeting, being always "on the go", disruptive or demonstrate other signs of hyperactivity.

While there are more precise definitions for these conditions, they are mostly subjective and open to various interpretations. ADD/ADHD are relatively new conditions and were probably defined as soon as a pharmaceutical company had a drug to use.

As more investigation is done on these disorders, more controversy is raised about possible origins and causes. It's likely that ADD/ADHD occurs because of a complex range of factors, including illnesses and a combination of susceptibility factors such as genetics, maternal diet during pregnancy and length of breast feeding. The child's exposure to various chemicals in both food and the environment and their current diet are also probable contributing factors.

Some chemicals and foods may act as a trigger for the disorder. Whatever the cause, it seems likely from the nature of the symptoms that ADD/ADHD has many contributing factors. No cases are identical, especially when dealing with children. ADD/ADHD, however, is definitely not a deficiency of Ritalin or any other drug.

Surveys suggest that as many as 49 per cent of boys and 27 per cent of girls are described as inattentive by their teachers, while serious deficits in attention appear to occur in at least three to 10 per cent of school-age children, making inattention among the most prevalent of all childhood neuro-psychological disorders. Many of these children are diagnosed as having ADD/ADHD.

Many studies identify a worsening of symptoms with certain foods or food additives; others link lead contamination, smoking and alcohol in pregnancy to developmental disorders in children. The possibility of chemical substances in the diet and the environment influencing ADD/ADHD is highly likely.

Sadly, little real evaluation of ADD/ADHD children is actually carried out. They are not routinely evaluated for chemical, nutritional or allergic factors, or assessed for behavioural or environmental issues arising from their home environment. Instead, they are given drugs. This is despite the fact that there is a growing body of scientific literature showing significant nutritional deficiencies in many of these children. There is growing evidence that a significant number of ADD/ADHD sufferers have a high body burden of heavy metals, particularly lead, mercury, cadmium and possibly even the trace element copper. These metals are potent toxins which block thousands of important chemical reactions in the body and can play havoc with the nervous system. At even moderate concentrations, lead can lower a child's IQ. Recent research links infant and maternal exposure to lead with higher rates of schizophrenia.

Nutritional deficiency is an underlying cause of ADD/ADHD in a significant number of children. Correcting these deficiencies and inbalances can make substantial improvements in childrens' behaviour. Sometimes improvement is almost immediate.

The basic problem appears to be deficient levels of neurotransmitters (chemicals that coordinate many of the body's and mind's activities) in brain cells. Various chemical substances affect the transmission of messages across the synapse, the gap between individual nerve cells. Acetylcholine, adrenalin, noradrenaline, dopamine, gamma-aminobutyric acid (GABA) and serotonin are all examples of neurotransmitters. Some of these chemicals are responsible for other chemical secretions and uptake. They control muscular activity, mood and behaviour. So you can see how they might be involved in ADD/ADHD.

Over-prescription of drugs, (particularly the amphetamine Ritalin, one brand name for methyl phenidate) that manage the symptoms of the disorder, is common. In Western Australia, in particular, the annual use of prescription amphetamine-like tablets prescribed for ADD/ADHD has exploded. There are many problems associated with taking these drugs. They include anorexia, weight loss, insomnia, lability of mood, nervousness and irritability, abdominal discomfort, excessive withdrawal symptoms, heart arrhythmias, palpitations and psychological dependence. Suicide is also a major complication of withdrawal from amphetamine-like drugs. Children on Ritalin are more prone to becoming addicted to smoking and illicit drugs. These drugs don't deal with the underlying cause. The US National Institute of Health has concluded that there is no evidence that Ritalin brings about any long-term benefit in scholastic performance.

These drugs have a noradrenaline-like action. Noradrenaline normally acts to coordinate many nervous system functions. It's thought to filter out unimportant stimuli, reducing the number of distractions sensed by the child. If ADD/ADHD is a noradrenaline shortage, it could be measured, but no one seems to want to do this. It's much easier (and more profitable?) to prescribe drugs. If it's a noradrenaline shortage, it can at least to some degree, be corrected by dietary measures.

There are many reasons as to why a child may have poor nutrition. These include being breast-fed for only a short period of time. Infant milk formulas and cows' milk are not the same as human milk. Cows' milk is great for a calf that needs to put on weight directly after birth. A cow's brain does not grow after birth. The human brain continues to grow substantially up to the age of three, and then more slowly, up to 18 years of age. It's not surprising then, that human milk is high in Essential Fatty Acids (EFAs) and choline, along with many other ingredients essential for the development of a healthy brain and nervous system. Both these nutrients are severely deficient in many infants' and children's diets, particularly if the diet is high in grains and processed foods.

One explanation for the higher rates of ADD/ADHD in males is that males have a higher demand for EFAs (Omega 3 oils). Males don't appear to absorb them well and are less efficient at converting them to an important group of chemicals called prostaglandins. Prostaglandins regulate many activities in the body and play an essential part in others. Many of the foods that are linked with ADD/ADHD also inhibit the conversion of the EFAs to prostaglandins. These are such foods such as wheat, dairy and salicylate-containing foods, including some of the food colours. Conversion is also blocked by deficiencies in Vitamins B3, B6, C, biotin, zinc and magnesium. There are many studies now that show the benefit of supplementing the diet with fish oils and flax seed oil, not only for adults but for kids being treated with Ritalin. What's also interesting about the EFAs is that many of our parents were dosed with them once or twice a week in the form of cod liver oil.

ADD/ADHD children appear to be deficient in a number of nutrients:
* Vitamin C
* Vitamin B3
* Zinc
* Magnesium; and
* Essential fatty Acids (Omega 3 rich oils).

It may be that there is an absence of these nutrients in the diet. It may be the effects of medication, stress, and other lifestyle factors, including exposure to some environmental contaminants, that have lead to nutritional deficiencies. For example, the use of antibiotics has been shown to have an effect on the nutritional status of children, as they deplete the body's levels of zinc, calcium, chromium and selenium. Antibiotics, other medication and food preservatives can also have a serious detrimental effect on the healthy gut bacteria which, in turn, affects the ability of the gut to absorb nutrients.

Academic performance and behavioural problems improve significantly when children are given optimal nutrition and nutritional supplements. In one study, supplementing with just 200 milligrams of magnesium for six months improved magnesium status and significantly reduced hyperactivity. Magnesium plays a key role in the production of noradrenaline. One of the main sources of magnesium in our diets is green vegetables, but few kids get enough of these. Other nutrients involved in the production of noradrenaline include manganese, iron, copper zinc, Vitamin C and Vitamin B6.

Noradrenaline formation may be affected by an absence of the amino acids L-phenylalanine or L-tyrosine, which are its building blocks. Vitamins B1, B2, B3, B6, Vitamin C, Folic acid and the minerals zinc, magnesium and copper are necessary for the conversion of phenylalanine and tyrosine to noradrenaline.

It has been proposed for many years that food additives and other food constituents can contribute to ADD/ADHD. While this is refuted by the food additive industry, there's growing evidence that this is the case. It's also becoming apparent that there are biochemical explanations as to why some foods and food additives, particularly the food colours, may be contributing factors. For example, salicylates inhibit the conversion of the EFAs to the protective prostaglandins, as mentioned earlier. Many foods that contain salicylates - tomatoes and granny smith apples, as well as aspirin and the food colours like tartrazine (102) - may exacerbate ADD/ADHD.

Food additives linked with ADD/ADHD can also deplete the body of vitamins and minerals. Tartrazine decreases blood levels of zinc and increases its excretion in the urine.

The diet of the pregnant and breast-feeding mother is very important. Infant and early childhood health conditions have a big role in the health of middle childhood. This is supported by research on alcohol exposure at various stages of pregnancy, hence the importance of good foetal and childhood nutrition.

What to do about food

For any child with ADD/ADHD it's important to identify foods that may be causing a problem. This is best done with a professional such as a naturopath, or a doctor specialising in nutritional and environmental medicine. With these professionals you can devise an elimination diet to identify potential environmental and dietary culprits. Some of the culprits are shown below.

The main foods causing sensitivities and allergies include:

• Cow's milk and associated dairy products
• Some legumes - soybeans, peanuts
• Nuts and seeds -pistachio nuts, cashews, macadamia nuts, cottonseed
• Crustaceans - shellfish, shrimps
• Fruits (non-citrus) - cherry, apple
• Citrus Fruits - oranges, lemons, limes
• Wheat and Other Grains - corn, rice, rye, oats, barley, buckwheat
• Cola nut products - chocolate, cola
• Spices - cinnamon, bay leaf, peppers, peppermint, oregano, sage, thyme, cumin
• Food Additives - coal tar dyes, preservatives, flavour enhancers, artificial sweeteners
• Caffeine - coffee, tea, chocolate, cola drinks.

The brain uses only glucose for energy. The research on sugar suggests that it may not be a major factor in ADD/ADHD. However, brain glucose that comes in waves of high highs and low lows is likely to affect a kid's mood.

Professor Peter Dingle
is Associate Professor
in Health and the Environment
at Murdoch University
in Western Australia.

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