Sunday, August 9, 2009

Autism | ADHD - Supplement ideas from Daniel Amen

Supplement ideas from Daniel Amen

28 Aug 2006

Amen Clinics Inc.
Supplements to Enhance the Brain
A Summary of Ways to Optimize Brain Function and Break Bad Brain Habits.

By Dr. Daniel G. Amen

Through the years many people have asked me about natural treatments. At least once a month a parent tells me about an amazing new treatment for ADD, depression, anxiety disorders, and so on. Vitamins, herbs, fish oil, amino acids, grape seed extract, and magnets to name a few. Having three ADD children of my own keeps me with an open mind. I want to know about everything that works to help the brain. Through the years I have tracked each of these treatments, kept up on the sparse scientific literature where it exists, and constantly stay on the lookout to see what works. Wading through the claims, parental excitement, and failures is challenging. The good news, however, is that many of these treatments are helpful, especially if you target the interventions to specific brain systems.

A word of caution: without looking through the lens of brain systems, some of these interventions clearly make things worse. Just because something is natural does not mean it's innocuous. Here's an example. Seven-year-old Justin was brought to see me by his mother. He had symptoms of ADD (short attention span, restlessness, and impulse control problems) along with temper problems. A month before I met Justin his mother read a magazine article on St. John's Wort. It said that it helped with mood and temper problems. She gave it to her son. Within a week Justin's behavior was much worse. He was more hyperactive, angrier, and he started to have dreams of decomposing bodies. When she stopped the St. John's Wort his symptoms lessened. During Justin's evaluation at my clinic I did a SPECT scan. It showed decreased activity in his left temporal lobe. I have often seen that serotonergic interventions like Prozac or St. John's Wort make temporal problems worse. It was clear to me that Justin needed an anticonvulsant medication and a stimulant. He had a very positive response to Depakote and Adderall.

Always check with your doctor before adding supplements to medication.
Some supplements will interact with medication, so caution is needed.
In this chapter I will go through each brain system and tell you what supplements that I have seen to have clinical benefit. I'll give you the rationale and dosage protocols that I suggest to my patients. If you decide to use these supplements instead of medication, as many people do, make sure you keep tabs on their effectiveness. I only want my patients to take something that is clearly beneficial to them. I also want them to take medication if the supplements are not effective. Many parents say that they want to try the natural supplements before they try medication. I'm not opposed to that, but I worry that if the supplements are not fully effective that they will not pursue more effective treatments. Follow through to find what works for yourself or your child. Be open to new ideas and persist until you get the best brain and life functioning.

No Matter What Brain System Problem Exists - 100% Multivitamin and Mineral Supplement

No matter what brain system problem exists for you or your child has take a 100% vitamin and minerals supplement a day. When I was in medical school the professor who taught our course in nutrition said that if people eat a balanced diet they do not need vitamin or mineral supplements. I have seen that balanced diets are a thing of the past for many of our "fast food families." In my experience, many families have problems with planning and tend to eat out much more frequently than in years past. Protect yourself and you child by taking a 100% vitamin and mineral supplement. In a 1988 study published in the British Journal Lancet, 90 children between the ages of 12 and 13 were divided into three groups. One group took no tablet, one group took a typical multiple vitamin and mineral tablet, and the last group took a tablet that looked and tasted just like the vitamin and mineral tablet, yet contained no vitamins or minerals. The results of this well controlled study was that the group who took the vitamin and mineral tablet had a significant increase in nonverbal intelligence, while the other two groups showed no difference at all. The subclinical vitamin and mineral deficiency may have been contributing to these students performing below their abilities.

Prefrontal cortex problems (typical ADD like symptoms)

People with PFC (prefrontal cortex problems) seem to have lower availability of the neurotransmitter dopamine. I frequently prescribe the amino acid L-tyrosine in doses of 500-1500mg two to three times a day for adults and 100-500mg two to three times a day for children under 10. L-tyrosine is the amino acid building block for dopamine. It is reported to increase the level of phenylethylamine (PEA), a mild stimulant that is found in high concentrations in chocolate. Many of my patients have reported that it is helpful for them. It is softer in its effect, but nonetheless they notice a positive effect. Because of absorption patterns I recommend that they take it on an empty stomach (a half-hour before meals or an hour after meals). I have not seen any side effects with L-tyrosine, except for mild weight loss. If there are cingulate problems, l-tyrosine by itself can increase the intensity of overfocused symptoms. Symptoms of tyrosine deficiency include hypothyroidism, low blood pressure, low body temperature (cold hands and feet), and restless leg syndrome.

Grape seed or pine bark extract has also shown some mild benefit for pfc issues. Grape seed or pine bark extract are proanthocyanidin compound. These compounds have been found to increase blood flow and they act as superantioxidants, 20-50 times as powerful as vitamin E. There are no published studies with grape seed or pine bark extract in ADD, but there are a number of published case reports. There is a body of medical literature that says these compounds are very helpful for people with varicose veins. If you have ADD and varicose veins then grape seed or pine bark extract may be for you.

Crystal, age 48, came to the clinic for symptoms of ADD. Her whole life she had been restless, inattentive, easily distracted, terribly disorganized, and impulsive. After her third child she also developed terrible varicose veins, which I had noticed in the initial interview. When we talked about treatment options for her Type 1 Classic ADD she said that she wanted to try the grape seed extract. Then she would see about other options. After 3 weeks she noticed that she felt better energy and her legs looked and felt better. Eventually we added L-tyrosine to give her more help with focus, but the regimen has worked well for her over the past several years.

Cingulate Hyperactivity

Cingulate hyperactivity appears to be due to a relative deficiency of serotonin. I often use St. John's Wort or 5-HTP (5-hydroxy-tryptophan) to help boost serotonin levels in the brain. St. John's Wort comes from the flowers of the St. John's Wort plant (wort is Old English for plant). It got its name from the fact that it blooms around June 24, the feast day of St. John the Baptist and the red ring round the flowers when crushed looks like blood, the blood of the beheaded John the Baptist. St. John's Wort seems to be best at increasing serotonin availability in the brain. The starting dosage of St. John's Wort is 300mg a day for children, 300mg twice a day for teens, and 600mg in the morning and 300mg at night for adults. Sometimes I'll go as high as 1800mg in adults. The bottle should say that it contains 0.3% hypericin, which is believed to be the active ingredient of St. John's Wort. I have done a number of before and after SPECT studies with St. John's Wort. It clearly decreases cingulate gyrus hyperactivity for many patients. It also helps with moodiness and trouble shifting attention. Unfortunately, I have also seen it decrease prefrontal cortex activity. One of the women in the study said, "I happier, but I'm dingier." When cingulate symptoms are present with ADD symptoms it's important to use St. John's Wort with a stimulating substance like L-tyrosine or a stimulant such as Adderall. It has been reported that St. John's Wort increases sun sensitivity (you could get sunburned more easily and need to be careful in the sun). Also don't use it if temporal lobe symptoms are present, without first stabilizing the temporal lobes.

Elaine, 16, had always been a worrier. She also had problems with anger at home. If things did not go her way she would explode at her parents or at her younger sister. As a student she was a perfectionist, which caused her to spend excessive time on assignments. Her mother, a school principal brought her to my clinic after she heard me lecture. She told me that she was sure Elaine had cingulate symptoms and ADD. Her SPECT study showed marked increased activity in her anterior cingulate gyrus. She also had mild decreased activity in her prefrontal cortex. I placed her on St. John's Wort, 600mgs in the morning and 300mgs at night. I also had her take L-tyrosine 500mg two to three times a day. Within a month Elaine was much better. She was more relaxed, less reactive, and did much better in her classes. She said that studying was easy because she no longer felt the need to have everything just so. She still wanted to excel, but didn't have to copy pages over three and four times until things were perfect.

Serotonin Pathway

Tryptophan

5-HTP

Serotonin

N-acetly-serotonin

Melatonin
L-tryptophan (the amino acid building block for serotonin) and 5HTP (also a serotonin building block) are other ways of increasing cerebral serotonin. L-tryptophan was taken off the market a number of years ago because one contaminated batch, from one manufacturer, caused a rare blood disease and a number of deaths. The L-tryptophan actually had nothing to do with the deaths. L-tryptophan is a naturally occurring amino acid found in milk, meat and eggs. I have found it very helpful for patients to improve sleep, decrease aggressiveness, and improve mood control. In addition, it does not have side effects, which is a real advantage over the antidepressants. L-tryptophan was recently re-approved by the Food and Drug Administration and is now available by prescription. I recommend L-tryptophan in doses of 1,000-3,000 milligrams taken at bedtime. One of the problems with dietary L-tryptophan is that a significant portion of it does not enter the brain. It is used to make proteins and vitamin B3. This necessitates taking large amounts of tryptophan.

5-HTP is a step closer in the serotonin production pathway. It is also more widely available than L-tryptophan and it is more easily taken up in the brain. Seventy percent is taken up into the brain, as opposed to only three percent of L-tryptophan. 5-HTP is about five to ten times more powerful than L-tryptophan. A number of double blind studies have shown that 5-HTP is as effective as antidepressant medication. 5-HTP boosts serotonin levels in the brain and helps to calm cingulate gyrus hyperactivity (greasing the cingulate if you will to help with shifting of attention). The dose of 5-HTP for adults is 50-300mg a day. Children should start at half dose. Take 5-HTP and L-tryptophan on an empty stomach. The most common side effect of 5-HTP is an upset stomach. It is usually very mild. Start slowly and work your way up slowly.

There have also been some recent studies with Inositol, from the B vitamin family, which you can get from a health food store. In doses of 12-20 milligrams a day it has been shown to decrease moodiness, depression and overfocus issues.

Do not take St. John's Wort, L-tryptophan, or 5-HTP with prescribed antidepressants, unless under the close supervision of your physician.

Temporal Lobe Issues

From a medication standpoint I have seen antiseizure (also called anticonvulsant) medications be the most helpful for temporal lobe problems. One of the mechanisms these medications work is by enhancing the amino acid gama-aminobutyric acid (GABA). GABA is an essential neurotransmitter in the brain. It is formed in the body from glutamic acid. It's function is to decrease neuron activity and inhibit nerve cells from overfiring or firing erratically. GABA can be taken as a supplement. It acts like an anticonvulsant and also as an anti-anxiety agent. In the herbal literature it is reported to work in much the same way as diazepam (Valium), chlordiazepoxide (Librium), and other tranquilizers, but without fear of addiction. I have seen it have a nice calming effect on people who struggle with temper, irritability, and anxiety (all which may be temporal lobe symptoms). The doses of GABA range from 100-500mg a day for adults, half that for children.

Many people with temporal lobe problems suffer from memory problems. I have found a number of natural substances helpful to enhance memory. These include:

Phosphatidyl Serine (PS): PS plays a major role in determining the integrity and fluidity of brain cell membranes. Normally the brain can manufacture sufficient levels of PS, but if there is a deficiency of folic acid or vitamin B12, or essential fatty acids, the brain may not be able to make enough. Low levels of PS are associated with memory problems and depression in the elderly. I often recommend PS as a supplement for memory problems. There are 18 double blind studies that report how effective PS can be for memory issues. In the largest study 494 elderly patients (65-93) with moderate to sever senility were given PS (100mg three times a day) or placebo for six months. The patients were assessed for cognitive function, behavior, and mood at the beginning and end of the study. Statistically significant improvements in all three areas were noted in the PS group. I recommend that my patients take 100mg twice a day for 2 weeks then, if needed, 100mg three times a day for memory.

Gingko biloba, from gingko trees, is a powerful antioxidant that is best known for its ability to enhance circulation. In a number of studies at major universities gingko biloba has been shown to improve energy, concentration, focus, and memory. Gingko biloba has been reported to enhance cerebral blood flow and reduce or slow the symptoms of Alzheimer's Disease. There are many different forms of gingko, making dosing confusing. Ginkoba and Ginkgold (Nature's Way) are brands that have been compounded to reflect those done in the major studies on gingko biloba. I recommend doses of 60-120mg twice a day

Vitamin E is an antioxidant that has been shown to be helpful for many things, including memory problems and muscle movement disorders. Doses of 400-600 IU twice a day are often recommended for enhancing memory.

Ibuprofen: an anti-inflammatory pain medication has been shown in several studies to enhance memory and decrease the progression of Alzheimer's Disease. It probably works by decreasing inflammation in the brain and allowing better circulation. Doses of 200mg twice a day are usually recommended.
Limbic Hyperactivity

Limbic hyperactivity has many symptoms of mild depression, including negativity, sadness, feelings of hopelessness, and an overabundance of ANTs (automatic negative thoughts). The supplements that seem to help limbic hyperactivity best are DL-phenylalanine (DLPA), L-tyrosine, and S-Adenosyl-Methionine (SAMe).

DLPA is the amino acid precursor for norepinephrine. In a number of studies norepinephrine and epinephrine (adrenaline) have been shown to be low in both ADD and depression. The antidepressants imipramine, desipramine, and the new one Reboxitine work by increasing norepinephrine in the brain. By boosting norepinephrine's precursor it makes sense that DLPA can have a positive impact on mood and focus. In fact, in a number of studies DLPA has been found to be helpful for depression, energy, and pain control. I have used it for 15 years as a mild antidepressant in children, teens, and adults. It is more mild in its effect than prescribed antidepressants, but it also has significantly less side effects. People who have PKU (phenylketonuria) should not take DLPA, as they do not have the enzyme that metabolizes it. I recommend doses of 400mg three times a day on an empty stomach, half that dose for children.

Victor, a 17-year-old high school senior came to see me at his own request. I did an assembly lecture at his school on the brain. He said that he often felt negative, had too many ANTs, and always disorganized. He didn't want to take medication but wanted to know if there were "natural things" he could do. I had him exercise, eat a more balanced diet, and take DLPA 400mg three times a day on an empty stomach. Within 2 weeks he called me and said that he felt much better, more focused, more energetic, and more positive. He recently wrote me from college saying he had remained faithful to his regimen and continued to feel well three years later.

SAMe is involved with the production of many important brain compounds, such as neurotransmitters. It donates "methyl" groups to these compounds so that they can function properly. Normally, the brain manufactures all the SAMe it needs from the amino acid methionine. In depression, however, this synthesis has been found to be impaired. Supplementing the diet with SAMe has been found to increase the neurotransmitters involved with depression and improve cell membrane fluidity. SAMe is one of the best natural antidepressants, a number of recent studies have shown that it is as effective as antidepressant medication. SAMe has also been found helpful for people who suffer from fibromyalgia, a chronic muscle pain disorder. Fibromyalgia and ADD run commonly together. I think the chronic stress associated with ADD is in part responsible for the muscle pain. People who have bipolar disorder or manic-depressive illness should not take SAMe. There have been a number of reported cases of SAMe causing manic or hypomanic episodes (excessively up or happy moods, extreme impulsivity in sexuality or spending money, pressured speech, or decreased need for sleep). I think these reports highlight that SAMe is an effective antidepressant, as all of the prescription antidepressants have that capability as well.

The dosage of SAMe is between 200mg to 400mg two to four times a day, half that for children. One of the problems with SAMe is that it is expensive, as expensive as many of the newer antidepressants. Insurance companies do not, in general, cover herbal or supplemental treatments, making SAMe even more expensive than prescription medication for most people. Over time the cost is likely to come down.

Natural Treatments Summary Sheet

Through the years, many people have asked me about the best natural treatments for brain disorders. Here is a list of interventions that I have found helpful.

Dietary/Lifestyle Issues - These are very important. They can decrease the amount of medication needed.

Many people with ADD do better on higher protein, lower "simple" carbohydrate diet

Protein is found in meat, eggs, cheese, nuts, and beans

Decrease the amounts of simple carbohydrates, such as sugar, corn syrup, honey, candy, white bread, white flour, white rice, potatoes without the skin, white pasta

Eat more complex carbohydrates, such as fruits (oranges, tangerines, pears, grapefruit, apples, kiwi, but not grapes, dates or bananas) and vegetables

Increase the amounts of Omega 3 Fatty Acids in the diet and through supplements. Omega 3 Fatty Acids are found in cold water white fish, such as tuna and salmon, walnuts, Brazil nuts, olive and canola oil

Decrease artificial colors (especially red and yellow) and food additives (nitrites, msg, aspartane, etc.)

Eliminate caffeine, nicotine

Evening carbohydrates help sleep

Intense aerobic exercise for 20-30 minutes 5-7 times a week

Diagphragmatic breathing - deep breaths in and out, for anger and anxiety control

Proper sleep (7-8 hours)

Amino Acids, Herbal Substances - for specific conditions these interventions can be helpful, but just do one at a time to see if it is indeed helpful for you or your child.

SAMe (s-adenosyl methionine) 200mg a day, increase to 200mg twice a day, and increase by 200 mg a week up to 1,600 mg a day for depression, fibromyalgia, and focus

Omega 3 Fatty Acids, evening Primrose oil + deep fish oil or Efalex Focus, Nature's Way, (omega-3-fatty acid supplement) 450 mg tab, 1rst 12 wks 4 twice/day w/food, then 1 twice/day (1/2 dose 5 and under)

Tyrosine: 1,000-1,500mg for energy, focus, impulsivity (this is the amino acid precursor for dopamine)

Phosphatidyl Serine: 100mg twice a day for 2 weeks then 100mg three times a day for memory (see the book Memory Cure for details)

Gingko Biloba (Ginkoba, Ginkgold): 60-120mg twice a day for energy, concentration and focus (to enhance cerebral blood flow)

Vitamin E 400-800 IU BID for memory

Ibuprofen 200 mg BID for memory

Pycnogenol (OPC grape seed or pine bark) 1mg/pound a day for concentration, focus and mental clarity.

Gotu kola for memory

Inositol: 12mg/day for depression and panic disorder, 18mg/day for OCD symptoms

Tryptopohan: 1,000-3,000mg for sleep, depression, overfocus issues (this is the amino acid precursor for serotonin)

DL-phenylalanine: 400 mg three times a day on an empty stomach for depression, energy and pain control (this is the amino acid precursor for norepinephrine)

St. John's Wort (0.3% hypericin) 500mg twice a day for depression and overfocus issues (250 mg twice a day for children)

Kava 60 mg 2-3 times a day, for anxiety, depression and insomnia (not more than for 3 months straight)

Valerian extract, standardized, 300-500 mg for insomnia and anxiety

Melatonin: 1mg to enhance sleep

Octacosanol 2,000 micrograms (oil capsule) 2-4 capsules a day for brain injuries


If you have any questions or would like to set up a consultation with an
Amen Clinic doctor please call the clinic nearest you.
© 2006 Amen Clinics Inc., A Medical Corporation, All Rights Reserved.

Daniel Amen

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