ADHD and Nutritional Interventions: Part I

27 Mar

The interest in complementary and alternative treatments for Attention Deficit Hyperactivity Disorder (ADHD) is fueled, in part, by disappointment with established treatments. It is well established that FDA/TGA approved medications demonstrate a large benefit for ADHD symptoms for up to 2 years, however, there is no conclusive evidence of benefit beyond two years. This being so, approved medications may not benefit all cases. This being so, research is looking to advance its knowledge and understanding of the potential benefits complementary health could afford individuals diagnosed with ADHD. So what has been noted thus far?

Nutritional Intervention 1: Elimination Diet
Approximately 12 placebo controlled studies have explored elimination of various foods (wheat, corn and dairy) or additives (colours, preservatives, and artificial flavours) suspected of a deleterious behavioural effect regarding ADHD symptoms. Most of the studies have looked to eliminate dyes, flavours, mono-sodium glutamate, chocolate, caffeine, preservatives and dairy and only allowed a small amount of sugar to be consumed. On average 60 percent of participants established improved sleep and behaviour with the elimination of the foregoing foodstuff.

Nutritional Intervention 2: Protein Intake
Children with ADHD have been shown to have low levels of certain amino acids, and also demonstrate nitrogen wasting, which can indicate poor use of protein. Several essential amino acids are utilised to make neurotransmitters (tryptophan, tyrosine and phenylalaine), to support how the nervous system functions (Memory and Learning). Unfortunately, there are only short term benefits for individuals diagnosed ADHD, when supplementation of the foregoing amino acids are used (2 months, maximum). A safer, and potentially more effective approach is to utilise a high quality protein diet. Adequate protein intake for Boys and Girls (between the ages of 4 and 13 years), is calculated at 0.95g/kg/bw.

Nutritional Intervention 3: Essential Polyunsaturated Fatty Acids

Lower levels of both omega-3 and omega-6 fatty acids have been observed in ADHD compared to controls (“typical Developing Child”). However, severity of ADHD symptoms often correlated with lower levels of omega-3 and higher levels of omega-6. There are currently 17 published placebo-controlled RCT studies on children diagnosed with ADHD. Of these assessments, the majority unfortunately demonstrated little to know effect in reducing symptoms of ADHD. Nonetheless, recent research on the effect of combined Vitamin C (50 mg) and Flax Oil (corresponding to 200 mg of ALA) therapy is encouraging. Combined vitamin C and Flax Oil therapy over 3 months was shown to reduce inattention, impulsivity, restlessness and improve self-control.

In part two of this article, I will discuss the following nutritional interventions: Herbs (St. John’s Wort, Ginkgo Biloba, Valerian and Kava, Pycogenol), Supplements (L-Carnitine, Melatonin, Magnesium, Iron and Zinc) and the potential benefits and risks of utilising such therapies for ADHD.

Alzheimer’s Disease: Antioxidants

20 Feb

Alzheimer’s disease (AD) is the most prevalent neurodegenerative disease without known cure, clinical manifestations of AD are severe impairments in thought, memory, learning and language abilities. In recent times, researchers have identified multiple factors in the pathogenesis (origin) of AD, of particular note, oxidative stress. As previously mentioned, increases in oxidative stress can compromise how proteins in the body behaviour. Certain proteins (e.g. beta-amyloid), specific to Alzheimer’s, if oxidised, can behaviour in ways that challenge thought, memory, learning and language. For this reason, scientists have looked at possible strategies to combat increases in oxidative stress.

Several studies have shown that individuals diagnosed with AD present with decreased levels of plasma (blood) antioxidants and total plasma antioxidant activity (basically, is the antioxidant producing a positive outcome in the body to reduce the likelihood of damaged or compromised cells). Antioxidants, in theory, are capable of combating oxidative stress and reducing its impact on the body. This being so, is it possible to utilise antioxidants to effect a change in individuals diagnosed with AD?

1. Antioxidant (Polyphenolic) Compounds in Green Tea:

Green Tea is particularly rich in flavonoids, including catechins. Catechins in green tea have been found to restore the activity of the mitochondria in specific regions of the brain (hippo-campus, cortex and striatum). As you may be aware, mitochondrial damage increases oxidative stress. At this point in time, the catechins in green tea have been shown to possibly protect against beta-amyloid mediated cognitive impairment.

2. Antioxidant Compounds in Magnolia:

Magnolia extract includes several antioxidant compounds, of particular note, flavonoids. Research has found that the active component of Magnolia, Magnolol, administered orally at dosage of 1-2 milligrams per kilogram of body weight, may prevent age-related learning and memory impairment.

3. Antioxidant Compounds in Blueberries:

Blueberries contain a number of antioxidant compounds, including catechins and flavonoids. Research has shown that blueberries share both anti-inflammatory and anti-oxidant properties. According two studies, blueberry extract may be capable of activating pathways in the brain responsible for cognitive function, learning and memory.

There is abundant evidence implicating oxidative stress in AD, however, further research is required specific to the potential role that antioxidants play in AD.

Can Whole Beetroot Consumption Improve Running Performance?

29 Jan

Well, the short answer is yes! So, how is this possible? It is simply the result of a chemical known as nitrate.

Nitrates are commonly used for food preservation, especially in processed meats such as sausage and bacon, but are also found in drinking water and other foods. Nitrate intake has received both positive and negative critic, of particular note, nitrates endogenously produced nitroso-derivatives which have been linked to serious medical conditions such as cancer. However, it is important to realise that the nitrates found in vegetables, such as beetroot and celery, fail to produce the nitroso-derivatives found in processed meats, as the vitamin C and D content of these foods inhibit its formation. So feel free to consume vast amounts of celery and beetroot!
Previous studies using nitrate supplementation (sodium nitrate capsules or beetroot juice) at a dosage between 347 milligrams and 476 milligrams per day has been shown to enhance endurance performance. For this reason, researchers from the Academy of Nutrition and Dietetics in the United States sought to evaluate the hypothesis that the ingestion of 200 grams of whole baked beetroot (containing 500 milligrams of nitrates), before exercise, improves running performance during a 5 kilometre treadmill time trial.

In the foregoing study, eleven recreationally fit men and women underwent two 5 kilometre treadmill time trials in random sequence, the first 75 minutes post consumption of baked beetroot (200 grams, @ 500 grams of Nitrate) and the second, 75 minutes after consuming cranberry relish as placebo.

Average 5 kilometre run times ranged from 19.9 to 35.5 minutes, suggesting that participants were moderately fit. Results of the study found that running velocity was marginally faster (41 seconds) after beetroot consumption compared to placebo and that during the last 1.8 kilometres, beetroot consumption resulted in a 0.6 kilometre per hour running velocity. 0.6 kilometres per hour equates to running the final 1.1 kilometres approximately 1 minute faster than placebo. Moreover, during the first 1.6 kilometres the rating of perceived exertion was lower in the beetroot trial.

So, if you are running the park this Saturday (5 kilometre Park Run) perhaps you could incorporate beetroot as an ergogenic aid to enhance your running performance. It may be the difference between running in the 25 minute group or the 30 minute group.

If you have any questions regarding this article please write to info@markhincheynaturopathy.com.au or contact 0432234822

Updates on Complementary Treatment Approaches in Autism

23 Jan

Many families look to access complementary therapies in managing Autism Spectrum Disorder, with the hope of finding a solution that does not rely on pharmaceutical agents. Although, this approach may not afford every child or adolescent a significant reduction in behaviour, response and/or symptoms, the fact that there is a growing body of research supporting complementary therapies is grounds for consideration. The topics that follows will examine the most up-to-date research on complementary therapies for Autism Spectrum Disorder (ASD).

Complementary Therapy 1: Melatonin
Melatonin is a hormone released by the pineal gland (Brain) in response to decreasing levels of light. It causes drowsiness and sets the body’s sleep clock. Interestingly, ASD is associated with a high frequency of sleep problems and melatonin is increasingly used to help children with ASD fall asleep. So what is the verdict? Of the 18 treatment studies on melatonin all have shown positive results. On average, a dosage of 2 to 10 milligrams of melatonin is capable of increasing sleep duration by approximately 44 minutes, and reducing sleep onset by 39 minutes. Despite the benefits associated with sleep outcomes, there was no change to nighttime awakenings.

Complementary Therapy 2: Omega-3 Fatty Acids
Omega-3 Long Chain Fatty Acid supplementation is reasonable to consider given that omega-3 fatty acids are essential to brain function and development. The two omega-3 fatty acids of primary interest are eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA). Low level of both EPA and DHA have been reported in children with ASD. So what is the verdict? Currently, there are 6 peer reviewed studies on the effects of omega-3 fatty acid on ASD. The evidence to support its use is weak, however, it is important to note that of the research undertaking thus far, demonstrated modest reductions in hyperactivity, hypersensitivity, anger and aggression and irritability have been reported. Moreover, the association between improved mood and attention is largely based on data from other disorders, not ASD.

Complementary Therapy 3: Methycobalamin (Methyl B12)
There is research to suggest that oxidative stress (more reactive molecules in the body than antioxidants to counteract them) is associated with ASD. Certain pathways in the body (largely influenced via the liver) assist in the clearance of reactive molecules. However, clearance requires particular nutrient co-factors to support this process, Methyl B12 is one of these co-factors. In a study of 40 children diagnosed with ASD, administration of Methyl B12 (important with elevations in a non-protein known as homocysteine) for 1 month resulted in a significant increase to the body’s major antioxidant, glutathione. Along with an increase in glutathione came improvements in social relatedness, language and reductions in behavioural problems. So what is the verdict? Methyl B12 is typically administered at dosages of 64.5 to 75.0 mcg/kg with subcutaneous injections every 2 to 3 days. There are no peer reviewed studies in ASD of oral or nasal Methyl B12, which unfortunately are unable to maintain consistently high levels in the body, hence are considered less effective.

Complementary Therapy 4: N-acetyl-cysteine (NAC)
At the time of writing this article there was only one research publication available on the role of NAC in ASD. This study was a 12 week double blind randomised placebo controlled trial (the best possible study design, little room for variables) involving 31 boys and 2 girls, all between the ages of 3 and 10 years. So what is the verdict? NAC at 900 mg daily for 4 weeks was strongly associated with significant improvements in Aberrant Behavioural Checklist (symptom checklist for identifying problem behaviour) and irritability sub-scale. Yet, despite the success of the study the results will need to be replicated before recommendations can be offered.


Complementary Therapy 5: Pancreatic Digestive Enzymes

Enzyme deficiencies in children with ASD result in a reduced ability to digest protein, which affects the availability of amino acids crucial for brain function. For this reason there is a possible benefit in utilising a comprehensive digestive enzyme supplement with meals to aid digestion of all proteins and peptides, especially for those children with ASD that experience digestive issues. Moreover, probiotics have also been proposed to improve digestion and gut-brain activity in children with ASD. So what is the verdict? A recent high profile 2010 study demonstrated a modest improvement of ASD symptoms when utilising digestive enzymes. Yet despite a modest gain, what was largely exciting about this study is that showed that digestive enzyme supplementation allowed children diagnosed with ASD to consume a larger variety of foods, which they had not been previously able to tolerate. At present, there is a study underway known as the Cure-mark study. This study is looking to replicate and confirm the foregoing results. Researchers from The Institute of Genomics and Systems Biology in the United States have just released a groundbreaking paper that a Bacteroides fragilis probiotic is capable of relieving gastrointestinal symptoms in children diagnosed ASD! There are further trials underway. In case you did not hear my excitement. This is bloody fantastic!

Complementary Therapy 6: Micronutrients
Everyone likes to utilise multivitamins, yet, for the majority it is unfortunately a waste of money. That is, deficiencies provide grounds for multivitamin supplementation, not simply failing to feed yourself properly. However, given the nature of ASD and the accompanying symptomology of heightened sensitivity to foods, there is grounds for recommending micro nutrient supplementation if deficiencies exist. So what is the verdict? Two RCT clinical trials (Remember, the best studies, with little to no variable) have shown that micro-nutrient supplementation yielded significantly better sleep and reduced gastrointestinal symptoms (bloating, excess wind, loose motions, constipation). What was also interesting is that improvements were also noted in the pathways previously alluded too in the section, Methyl B12. Exciting!

If you have any question regarding this article please make contact via info@markhincheynaturopathy.com.au or 0432234822

Parkinson’s Disease: Diet and Complementary Therapies

14 Jan

One area that I am particularly interested in is Parkinson’s Disease. Over the last two years I have had the pleasure of working with several clients diagnosed with either early or late onset Parkinson’s.
Despite the condition being progressive, there is much value in delaying progress. This being so, science has started to examine the possible role that nutrition and complementary therapy may play in slowing the progression of Parkinson’s Disease.

There is a current hypothesis that Vitamin E and C might protect neurons and delay the degeneration of Parkinson’s Disease. It is suggested that some of the neuron degeneration in Parkinson’s is caused by an excess of oxidising chemicals in the body. For this reason, removing oxidising chemicals from the circulation may prove effective in protecting neurons. To neutralise (remove) oxidising chemicals we require antioxidants, two of which are Vitamin E and C.

A landmark pilot study in 1992 that examined the co-administration of high dose Vitamin E (alpha tocopherol) and Vitamin C (ascorbate) showed that combined administration of Vitamin E and Vitamin C reduced the progression of Parkinson’s Disease. Moreover, a large cohort study in 2002 demonstrated that high dietary vitamin E intake, but not Vitamin C, reduced the risk of Parkinson’s Disease. However, despite the foregoing research it is important to note that the results of double-blinded randomised controlled trials have been disappointing, where Vitamin E showed no benefits in Parkinson’s Disease.

Another neuroprotective agent, studied in recent times is, Creatine (an acid, largely produced by the liver that is capable of supplying energy to muscle and nerve cells in the body). Pre-clinical studies in various models have demonstrated the potential role as a neuroprotective agent. For example, in early clinical studies, 2 grams daily creatine administration improved behavioural difficulties in a clinical trial of 200 subjects who were within 5 years of a Parkinson’s Disease diagnosis. In an additional follow up study, 2008, creatine continued to show neuroprotective benefits 18 months following creatine administration. More recently, a phase III clinical trial (Trial of a large group, e.g. Excess of 1000 subjects) is under way by the National Institute of Health (to be completed in 5-7 years), where creatine is administered at a dose of 10 grams in a large long term study of Parkinson’s Disease targeting 1,720 participants with the disease (the study involved 52 medical facilities). We eagerly await the results!

Finally, the antioxidant Coenzyme Q10 also shows promise as a neuroprotective agent in Parkinson’s Disease. Postmortem studies have shown that Coenzyme Q10 levels in the plasma and platelets of Parkinson’s patients were significantly lower compared to aged matched controls, and that the oxidised form of Coenzyme Q10 was elevated in Parkinson’s patients (meaning greater use by the body). This information suggests that Coenzyme Q10 supplementation may prove beneficial. In a recent (2011) double-blind, placebo controlled phase II study, Coenzyme Q10 (at 3 different dosages- 300, 600 and 1200 mg daily) administration over 16 months, statistically improved the Parkinson’s Rating (scale to measure progression of Parkinson’s like symptoms), of all 80 untreated patients. However, it is to be noted that only the highest dosage of 1200 mg daily proved effective. A follow up, randomised, placebo controlled, double-blind study is now under way to assess the effect of administering 2400 mg daily to 600 early, non-medicated Parkinson’s patients.

Parkinson's

If you have any questions regarding this article, or additional health concerns, please feel free to contact me on 0432234822 or info@markhincheynaturopathy.com.au

Nutrition and Dietary Recommendations For Body Builders

8 Jan

I am not a body-builder, nor do I claim to be. However, I have been asked by clients who are, to write an article on nutrition for body-building. In this post I will primarily focus on protein dose per meal.

It is suggested that muscle protein synthesis rate (rate of muscle repair and building) can be maximised by an acute bolus (small) dose of protein in a given meal. For example, research has shown that there appears to be a maximal rate at which dietary amino acids can be assimilated into muscle tissue after training. Moreover, that with increasingly higher concentrations of amino acid, post workout, there is no further stimulation of protein synthesis. So what is the magic figure?

It has been advised that the acute dose of protein required post workout should stand at 20 grams of complete protein (a complete protein is an adequate source of all nine essential amino acids). 20 grams of complete protein will allow for maximal stimulation of muscle protein synthesis. However, what is most exciting is that 20 grams of complete protein is also capable of increasing the breakdown and utilisation of the amino acid leucine, a known trigger for larger muscular growth.

It has also been stated that the ingestion of approximately 20 grams of high quality protein, 5 to 6 times daily, could be one strategy to maximise the rate of protein synthesis. Some body-builders may argue that in following a restricted caloric intake, specific to carbohydrate and/or fat, there is a need to increase protein beyond 20 grams to compensate for caloric requirements. However, it is important to bear in mind that in following a restricted nutritional regime, lean muscle gains and recuperative ability at approximately a 20 gram dose of high quality protein per serving should be adhered to for at least 4 weeks before increasing protein per serving.

So what would 20 grams of complete protein look like, 5-6 times a day, if attempting to incorporate this regime into your nutrition protocol?

Meal 1: Breakfast

- Egg white omelette made with chicken and vegetables (1 cup of green
vegetables i.e. broccoli and spinach);
- Plus: 1 x cup of cooked oats (cooked with ¾ tsp. of cinnamon); or
current smoothie; however add 2 Flat tbsp. of Buckinis to Smoothie
(From Health food Shop).
- Plus: 1 x Nectarine/Peach/Grapefruit.

Meal 2: Snack

- 1 scoop of Protein Whey Concentrate in 1 cup of Almond Milk
- 1 x handful of Almonds

Meal 3: Lunch

- 1-2 grilled BBQ Chicken Breasts
- 2 handfuls of brown rice or quinoa
- 1 cup of any green vegetables (e.g. broccoli, green beans or
asparagus)
- 1 x apple, nectarine, peach or kiwi fruit

Meal 4: Snack

- 1 x cup of Greek Style Yoghurt + 1/3 cup of berries.

Meal 5: Evening Meal

- 1 x lean lamb steak grilled or baked salmon fillet
- 1 x medium sweet potato
- 2 x cups of mixed raw salad/vegetables
- ½ cup of fresh pineapple

Meal 6: 2 hours before bed

- 1 scoop of Casein Protein Supplement in 1 cup of Almond Milk
- 1 to 2 plain rice cakes topped with macro nut butter (e.g. almond or
cashew paste, peanut butter).

If you have any questions specific to body building and nutrition please feel free to write to info@markhincheynaturopathy.com.au or contact 0432234822.

Autism Spectrum and Gluten

14 Nov

I am currently enrolled in my PhD at The University of Newcastle. My area of focus is Autism Spectrum and Nutrition. I have just commenced writing a piece and thought I would share this information with you:

Introduction

Research examining the role nutrition plays in Autism Spectrum Disorder (ASD) has largely focused on individual dietary nutrients and/or proteins. Of particular note, significant attention has been given to the inclusion of gliadins, glutenins and casein in the diet of adolescents diagnosed ASD. Hence, there is currently a limit to systematic review, providing comprehensive assessment, on the function of nutrition in Autism Spectrum. For this reason, there remains confusion as to what nutrient interventions are valid and reliable to employ. With the foregoing in mind, it will be my intention, to provide a clear overview of the role nutrition plays in Autism Spectrum.

The Role of Gluten

It has previously been held that gluten may compromise digestive function in individuals diagnosed ASD. Anecdotal evidence combined with scattered references to the relationship between gluten and neuro-behavioural symptoms have largely persuaded practitioners to encourage a gluten-free diet. However, it is important to note that the foregoing theory is central to a link between behavioural disturbances and coeliac disease (gluten sensitivity). This being so, adherence to a gluten-free diet is, from a scientific perspective, specific to individuals diagnosed with positive anti-tissue-transglutaminase antibodies.
Recent literature, however, contends that gluten-rich grains, of particular note, wheat, may assist in strengthening the immune system. It is suggested that the high content of glutamine available in gluten-rich grain, and, naturally occurring fructan-type resistant starches (oligosaccharides) are responsible for this outcome. For example, supplementation with L-alanyl-L-glutamine has previously been shown to reduce the incidence of infectious complications in patients following surgery. Moreover, the administration of L-alanyl-L-glutamine and oligosaccharides to adolescent males, diagnosed ASD, reduced intestinal epithelial hyperpermeability, restored secretory IgA status and reduced elevations in plasma cytokines, of particular note, interleukin 6 and 12. Specific to digestion, whole grain wheat products are capable of creating a healthy composition of colon bacteria, which can protect against several inflammatory conditions including, intestinal epithelial hyperpermeability. Hence given that digestive function is often compromised in individuals diagnosed ASD, a review of the role gluten plays is necessary.

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