ADHD / Hyperactivity

-- End Ad Box --->				which there are two groups - prostaglandins and
SCRUTINIZING HYPERACTIVITY				leukotrienes. Cis alpha linolenic acid is converted to a
Introduction				substance termed eicosapentaenoic acid (EPA) which
In past centuries the health of children was mainly				is in turn also converted to prostaglandin.
threatened by ignorance of basic hygiene, inadequate				The source of the problem is that the enzyme
sanitation, contaminated water, poor nutrition and				necessary for the conversion process does not seem
infectious diseases. Epidemics of cholera and other				to work efficiently in the hyperactive child and adult,
water borne diseases contributed to the death of				with a resultant deficiency of PGE and leukotrienes.
thousands of children. Scarlet fever, measles,				The enzyme deficiency or inhibition could be attributed
whooping cough, diphtheria and typhoid did the same.				to among others elevated blood glucose levels, a diet
Identification of harmful bacteria and development of				consisting of too much saturated fat, refined sugar, the
methods of immunisation resulted to a large extent in				intake of alcohol and deficiencies of zinc, magnesium
the eradication of infectious diseases. With the advent				and vitamin B6.4
of modernisation conditions such as hyperactivity,				Preliminary studies on the effects of supplementation
attention deficit disorder and other learning disabilities				with essential fatty acids in Canada, USA, United
as well as an increase in chronic illnesses such as				Kingdom and South Africa have reported some
asthma, eczema, etc. have been seen. This brochure				degree of improvement.2,4
attempts to summarise observations concerning				5.2 Other Nutrients
hyperactivity, and its treatment from a dietetic				Two-thirds of hyperactive children studied were
viewpoint. The information, advice and				deficient in zinc.2 A deficiency of zinc, magnesium and
recommendations are of a general nature and are not				vitamin B6 blocks the formation of GLA.
specific to the particular circumstances of an individual.				A number of nutrients are essential to the proper
Hyperactivity in history				functioning of the nervous system and these are
The hyperactive child and adult have probably been				discussed under the heading - treatment of
around since the emergence of modern man.				hyperactivity.
Descriptions of clinical patterns as early as 400 BC				6. Sugar
appear similar to those currently labelled as				Clinical observations and parent reports suggest that
hyperactive. Heinrich Hoffman, a German physician,				refined sugars especially cane sugar triggers
first described hyperactivity in 1845. Since then, the				hyperactive behaviour. Two theories have been
hyperkinetic syndrome, commonly labelled as				proposed for this reaction. One is that a diet consisting
hyperactivity has captured public attention in practically				of refined carbohydrates influences the level of EFA.
every developed country in the world as increasingly				Another possibility is that certain sugars (glucose)
more children have been and are diagnosed as				influence brain neurotransmitter levels and therefore
hyperactive. Hyperactive characters abound in				the activity levels in hyperactive children.
literature and cartoons, the main characters in the				Researchers designed a study where children were
popular cartoons, Dennis the Menace and Bart				given one of three different breakfasts; one high in
Simpson being classic examples.				carbohydrates, especially refined sugar; the second
Hyperactivity defined				high in protein and the third high in fat. After each meal
Hyperactive children usually have Attention Deficit				children were challenged with fructose, glucose and
Disorder (ADD), leading experts to classify the malady				placebos. Children reported by their parents as
together as ADHD (Attention Deficit Hyperactive				hyperactive after eating sugar did indeed show an
Disorder). In the USA many children are labelled				increase in activity level when challenged with glucose
hyperactive or as suffering with ADD when they				after eating a high carbohydrate meal.9
attend school. There is some concern about "labelling"				Normal children challenged with sucrose had more
children when they do not respond in an acceptable				problems with attention after a high carbohydrate
way to the school, perhaps reflecting an inadequacy in				breakfast than after a high protein breakfast. The
the teachers rather than the pupils. Medication to				reverse was true for children with hyperactivity.12
suppress hyperactive children is often prescribed with				Another study showed that of 261 hyperactive children
side-effects such as dizziness, headaches, drowsiness,				who had five hour glucose tolerance tests performed
blurred vision, gastrointestinal problems and depression.				on them, 74% had abnormal glucose tolerance curves.
Incidence of hyperactivity				The predominant abnormality accounting for 50% of
The incidence varies from country to country				these results was a low, flat curve similar to that seen
depending on the criteria used for diagnosis. In the USA				in hypoglycaemia. Hypoglycaemia is a potent stimulus
the rate ranges from 5 to 22%. In Australia the rate of				for the production of epinephrine which could affect
incidence ranges from 8 to 12%.1 In the United Kingdom				behaviour.10
a small number of children are diagnosed as				Sugar may on occasion aggravate existing behaviour
hyperactive although referrals to child guidance clinics				disorders. Reducing the intake of sugar should be
have increased.2 Hyperactivity is believed to affect				encouraged. Rigid sugar free diets can be burdensome
10% of the South African population and is found in				and socially inhibiting for the hyperactive child. The area
every ethnic and socio-economic group.13				of sugar intake and behaviour requires much more
Characteristics of hyperactive children				research before any recommendations can be made.
Describing the characteristics of hyperactive children is				A study on the use of artificial sweeteners suggests
daunting because many of the symptoms are present				that some hyperactive children become non-compliant
in all children to some degree at some time.				and more aggressive when given large doses of
Hyperactivity has been found to be between four and				aspartame.9
nine times more common in boys.2,3				Treatment of hyperactivity
The hyperactive baby is restless, has feeding				It is important to rectify the essential fatty acid
problems and colic (intermittent and unexplained crying)				deficiency. The enzyme necessary for the conversion
and often has sleeping problems. Some fall asleep late				process of essential fatty acids does not seem to
and with difficulty while others wake up frequently or				work efficiently in the hyperactive child and adult.
early. The baby often cries incessantly and parents				Essential fatty acids need to be provided in a form
find that no amount of comforting, nursing or cuddling				which can be readily utilized. Human breast milk
pacifies the child.				contains relatively large amounts of GLA. Another
The hyperactive toddler lives in a constant state of				important source of GLA is the oil of the evening
overstimulation, is constantly moving, unable to sit still,				primrose flower which contains 9% gammalinoleic acid
always into everything and touching every object in				(GLA) while fish oil contains 20% eicosapentaenoic
sight. As the child becomes older the description				acid (EPA). These oils which are commercially
changes. They are always in motion, constantly				available should be provided in a ratio of 2 GLA to 1
fidgeting or shuffling their feet, can not stay at an				EPA (e.g. 500 mg Evening Primrose Oil to 250 mg Fish
activity long and can not read without quickly losing				Oil).4
interest. A large percentage of hyperactive children				Zinc, vitamins B6, C and E are catalysts necessary to
have an abnormal thirst with a normal urine output.				metabolize the essential fatty acids.6 Since most
Other symptoms are lack of concentration, temper				hyperactive children appear to be deficient in these
tantrums, impatience, quick frustration, clumsiness and				nutrients supplementation with them makes good
sleep disturbances. Hyperactive infants and				sense.
adolescents usually have a depressed immune				The B-group vitamins are particularly vital to the
system. Asthma, hay fever, otitis, eczema and other				hyperactive child as one of their main functions is to
atopic conditions are common.				regulate the central nervous system. Vitamin B1,
Most authorities agree that the major features of				thiamin, is involved in the maintenance of the central
hyperactivity can be categorized as academic				nervous system. A deficiency of Vitamin B2, riboflavin,
difficulties and behavioural abnormalities. Impulsiveness,				may lead to central nervous system symptoms such
low frustration tolerance, short attention span,				as headache, irritability and fatigue. Vitamins B6 and C
aggressiveness and low self-esteem are some of the				are involved in neurotransmitter synthesis.
symptoms exhibited. Almost all hyperactive children				Calcium acts as a co-factor in biochemical reactions in
have a high IQ, but poor concentration means they				the body and takes part in the generation of nerve
perform less well than they should in school and often				impulses throughout the nervous system. Magnesium
complain of headaches, asthma, hayfever and other				which is necessary for the growth and repair of body
respiratory disorders.				cells also assists the transmission of nerve impulses to
The characteristics of the hyperactive child tend to				the muscles and acts together with calcium. Vitamin D
intensify from birth to about 3 to 4 years of age, but				aids the absorption and utilization of calcium and
may have subsided by the time the child reaches 10 to				magnesium.
12 years of age. The child becomes more controlled				Zinc and chromium play a role in sugar balance by
and the hyperactivity could to some extent be				enhancing the action of insulin in promoting uptake of
outgrown.4				glucose. A glucose tolerance factor has been identified
Hyperactivity and allergies				as a natural form of chromium which seems to
Allergies to cereals and milk, even mother's milk is				potentiate the action of insulin. Supplementation with
often commonplace. For many years paediatricians				chromium has been shown to reduce glucose levels
and paediatric allergists have reported that a higher				and to improve glucose tolerance.11 Since abnormal
percentage of children with allergies have learning				glucose tolerance levels have been seen in some
disabilities and/or hyperactivity compared with those				hyperactive children supplementing with chromium and
children who do not have allergies.9 It has been				zinc may help.
estimated that up to 10% of primary school children				Although all the amino acids have certain unique
suffer from allergic reactions which exhibit in the				functions in the body a few are worth singling out. Four
classroom as behaviour and concentration problems.14				primary amines, serotonin, dopamine, norepinephrine
An allergy is an abnormal body reaction resulting from				and acetylcholine are synthesised from amino acid
sensitivity to certain substances. The most common				precursors and appear to be under dietary control.
types of allergies are asthma, eczema and hay fever.				Dopamine and norepinephrine are synthesised from
Often symptoms are not recognised as resulting from				tyrosine and phenylalanine (phenylalanine is metabolized
an allergy and will be treated over and over with				to tyrosine), serotonin is synthesised from tryptophan
medications which may help superficially. As soon as				and acetylcholine is synthesised from choline.
the medication is stopped, the symptoms flare up				Deficiencies of L-Taurine and glycine which both aid
again.				the regulation of the nervous system are possibly liked
Causes of hyperactivity				to hyperactivity, epilepsy and anxiety.
Data pertaining to the cause of hyperactivity is				The beneficial effects of large doses of vitamin C to
incomplete, but various factors have been linked to				alleviate common symptoms of allergy have been
hyperactivity. These include among others genetic				described, but not substantiated in controlled studies.
factors, smoking during pregnancy, artificial additives in				Anecdotal reports suggesting that lysine tablets relieve
food, refined dietary sugar and environmental				the symptoms of food allergy in some individuals are
pollutants. Inborn temperamental variations with				also undocumented.11 Methyl Sulphine Methane and
chemical differences in the brain are thought by some				calcium assist in allergic sensitivities.
physicians to be the cause. The reason for these				Although Feingold's hypothesis has not been
differences is unknown, but may be due to genetic				experimentally confirmed, elimination of food additives,
differences or anomalies in the development of the				colors, flavors and salicylates may be of benefit and is
baby before birth.				worth a try. Exclusion of sugar and refined
1. Prenatal influences				carbohydrates is also recommended. If such a diet is
Very little is known about prenatal influences but there				to be followed, attention should be paid to its possible
is a possibility that small birth size may sometimes lead				nutritional inadequacies and there should be some
to hyperactivity. Other variations in the mother's				nutritional counselling and vitamin supplementation. Small,
biological processes during pregnancy may contribute				frequent meals consisting of protein and unrefined
to the development of hyperactivity.5 It is well				carbohydrates should be emphasized.
documented that the use of alcohol during pregnancy				In Conclusion
may result in mental retardation (foetal alcohol				There appears to be a relationship between brain
syndrome) and hyperactivity. The amount of alcohol, if				function and nutrition. Studies on the effect of evening
any, that can be safely taken during pregnancy is				primrose oil and fish oil on hyperactivity have shown
unknown.6				improvement in behaviour patterns and learning ability.
2. Inborn temperamental differences				The diet of the hyperactive child should be
Although uncertain, many child psychiatrists reason that				supplemented with these oils as well as magnesium,
inborn temperamental differences caused by chemical				zinc, calcium, vitamin C and the B-complex vitamins.
differences in the brain may result in hyperactivity.5				The keys to managing the hyperactive child are
The brain is an extraordinary complex interconnection				dietary control, discipline and lots of tender loving care.
of nerve cells. It receives information from inside the				All children have strengths and weaknesses. By
body via nerve impulses, collates this information and				recognising and accepting the diversity of human
responds by initiating nerve impulses and secreting				personalities and abilities a foundation will be laid for all
chemical substances or neurotransmitters (dopamine				hyperactive children to achieve their scholastic and
and noradrenaline). When released, neurotransmitters,				developmental potential.
transmit signals across synapses to other neurons in				Research activity has increased and it is hoped that
the brain. These pass from the brain to other parts of				future research and clinical findings will lead to better
the body to stimulate, regulate and co-ordinate				treatment and understanding of hyperactivity.
activities in other organs and systems.				For access to correct combinations of specialised
When there is a deficiency of a particular				nutrients, see ADHD / Hyperactivity under
neurotransmitter, the nerve cells can not function				Children’s Needs on
effectively and the portion of the brain that it				REFERENCES
"operates" will not function correctly. Successful				1. Serfontein G. Add in adults - help for adults who
functioning of the nervous system depends on the				suffer from attention deficit disorder. Simon and
release of sufficient quantities of neurotransmitters.				Schuster, Australia. 1994: 9
Hyperactive children are probably deficient in some				2. Matthews P. Fast Food. Nursing Times. March 1986.
neurotransmitters.5 In many hyperactive children the				3. Colten H.R; Food Hypersensitivity, food allergies and
quantity of these transmitters probably increases with				hyperkinesis. Suskind R.M; Textbook of Pediatric
age, explaining why hyperactive children improve as				Nutrition. Raven Press, New York, 1981: 553-562.
they grow older.				4. Van der Merwe C.F. Hyperactivity, Medunsa. August
3. Heavy metal poisoning				1992.
Heavy metals such as lead, copper, cadmium and				5. Wender P.H; Wender E. The Hyperactive Child and
aluminium are thought to be a cause for hyperactivity,				the Learning Disabled Child - a Handbook for Parents.
especially where children live in industrialised areas.				Crown Publishers, 1978: 22.
These metals all affect the nervous system. The lead				6. Barnes B; Colquhoun I. The Hyperactive Child - what
content of environmental air has risen due to the higher				the family can do. Thorsons Publishers,
lead content of petrol and increased car ownership.				Northamptonshire. 1984: 19, 77.
Cadmium from parental cigarette smoke and aluminium				7. Feingold B. Why your child is hyperactive. New York:
from food cooked in aluminium foil containers also				Random House, 1985.
affect the nervous system.4,6				8. The Hyperactive Children's Support Group.
4. Food preservatives, additives, flavorants and				Information sheet - Health Visitor, 1980, 57;1: 87-93
colorants				9. Silver L.B. Attention-Deficit Hyperactivity disorder.
An allergist, Dr Benjamin Feingold,7 has proposed that				Clinical guide to diagnosis and treatment. Washington:
hyperactivity is caused by artificial food preservatives,				American Psychiatric Press Inc, 1992: 129-134.
flavors, colorants and natural salicylates. He reported				10. Langseth L; Dowd J. Glucose tolerance and
that 30 to 50% of hyperactive children could improve if				hyperkinesis. Food Cosmet. Toxicol. 16:129. 1978.
these were omitted from the diet. His hypothesis				11. Krause M.V; Mahan L.K. Food Nutrition and Diet
stemmed from his observations that in some people				Therapy. A textbook of nutritional care. Philadelphia:
salicylates cause allergic reactions such as asthma				W.B. Saunders Company, 1984: 633-668.
and eczema. When treating the asthma by removing				12. Kinsbourne M. Sugar and the hyperactive child. New
salicylates from the diet, he noted a behaviour change				England Journal of Medicine. Feb 3, 1994: 355-356.
as well as the disappearance of the asthma				13. Edmonds T.L. Hyperactivity, following a special diet
symptoms.				could help. Longevity. July 1995: 88-89.
Since many patients who are allergic to salicylates also				14. Ryan B.J. Cerebral Hazards in relation to food and
react to artificial colors and flavors, Dr Feingold further				environmental chemicals. The Hyperactive Children's
postulated that food colors and flavors may also have				Support Group of Southern Africa. Newsletter 25,
a behavioural effect similar to that of salicylates in				Fourth quarter 1995.
those people who are sensitive to them.				Glossary
The food colorant tartrazine increases the urinary				ADD - Attention Deficit Disorder. Developmental
excretion of zinc. Food colors and flavors are found in				dysfunction of the central nervous system.
foods such as luncheon meats, sausages, hot dogs,				Allergy - Unusual sensitiveness to the action of
jams, sweets, cake mixes and flavored cold drinks.				particular foods, pollens, dust, etc.
Dietary sources of salicylates are found in apples,				Amino acid - Organic acid containing the group
peaches, oranges, tea and worcester sauce.				nitrogen, especially as a constituent of protein.
Most dietary-crossover studies eliminating foods				Asthma - Disease especially allergic of respiration.
containing salicylates, food colors and flavors by a				Diphtheria - Acute infectious bacterial disease with
number of researchers have not been able to				inflammation of mucous membranes, especially throat.
substantiate Dr Feingold's theories. Some studies, on				Eczema - Inflammation of skin.
the other hand, have provided data in support of the				Enzyme - Any of a unique class of proteins which
Feingold diet. The final answers are not yet in as there				accelerate a broad spectrum of biochemical reactions.
is insufficient evidence on whether the Feingold diet				Food Additives - Added to food to color, preserve or
genuinely works.				flavor.
5. Deficiency of nutrients				Hay Fever Summer disorder caused by allergy to
5.1. Essential fatty acids				pollen or dust often with asthmatic symptoms.
Research4,8 concludes that hyperactive children have				Neurotransmitter - Chemical substances when
a deficiency of essential fatty acids (EFAs) either due				released, transmit signals across synapses to other
to an inability to absorb EFAs adequately from the				neurons in the brain to stimulate, regulate and
gastrointestinal tract or because their EFA				co-ordinate activities in other organs and systems of
requirements are higher. A deficiency of EFA in				the body.
animals causes a constant thirst which is one of the				Otitis - Inflammation of the ear.
symptoms of numerous hyperactive children.				Salicylate - Salt of salicylic acid. Found in almonds,
EFAs are needed to form Prostaglandins (PGE) which				apples, apple cider, apricots, blackberries, cherries,
are vital regulators in the body. They participate in the				cloves, cucumbers, currants, gooseberries, grapes,
regulation of blood pressure, heart rate, blood clotting				nectarines, oil of wintergreen, oranges, peaches, pickles,
and the central nervous system. They are essential				plums, prunes, raisins, raspberries, strawberries and
because the body cannot manufacture them and has				tomatoes. Food with added salicylates for flavoring
to obtain them from dietary sources. There are two				may be ice-cream, bakery goods (except bread),
EFAs essential to man - linoleic acid and cis alpha				candy, chewing gum, soft drinks, jam, cake mixes.
linolenic acid.				Typhoid - Infectious bacterial fever with eruption of red
EFAs are converted by the enzyme				spots on chest and abdomen with severe intestinal
delta-6-desaturase to gammalinoleic acid (GLA) which				irritation.
is then converted to another substance called				Worcester - Pungent sauce first made in Worcester
dihomo-gamma-linolenic acid. This in turn is converted				(United Kingdom).
to hormone-like substances called eicosanoids of

Dc Parents

ADHD / Hyperactivity

More in Articles