Reflections on the increase in Autism, ADHD, anxiety and depression: Part 2- Exposure to neurotoxins and ultra-processed foods
Posted: June 30, 2024 Filed under: ADHD, attention, behavior, CBT, digital devices, education, emotions, Evolutionary perspective, health, mindfulness, neurofeedback, Nutrition/diet, Uncategorized | Tags: ADHD, anxiety, depression, diet, glyphosate, herbicide, herbicites, mental-health, neurofeedback, pesticides, supplements', ultraprocessed foods, vitamins 4 CommentsAdapted from: Peper, E. & Shuford, J. (2024). Reflections on the increase in Autism, ADHD, anxiety and depression: Part 2- Exposure to neurotoxins and ultra-processed foods. NeuroRegulation, 11(2), 219–228. https://doi.org/10.15540/nr.11.2.219
Look at your hand and remember that every cell in your body including your brain is constructed out the foods you ingested. If you ingested inferior foods (raw materials to be built your physical structure), then the structure can only be inferior. If you use superior foods, you have the opportunity to create a superior structure which provides the opportunity for superior functioning. -Erik Peper
Summary
Mental health symptoms of attention deficit hyperactivity disorder (ADHD), Autism, anxiety and depression have increased over the last 15 years. An additional risk factor that may affect mental and physical health is the foods we eat. Even though, our food may look and even taste the same as compared to 50 years ago, it contains herbicide and pesticide residues and often consist of ultra-processed foods. These foods (low in fiber, and high in sugar, animal fats and additives) are a significant part of the American diet and correlate with higher levels of inattention and hyperactivity in children with ADHD. Due to affluent malnutrition, many children are deficient in essential vitamins and minerals. We recommend that before beginning neurofeedback and behavioral treatments, diet and lifestyle are assessed (we call this Grandmother therapy assessment). If the diet appears low in organic foods and vegetable, high in ultra-processed foods and drinks, then nutritional deficiencies should be assessed. Then the next intervention step is to reduce the nutritional deficiencies and implement diet changes from ultra-processed foods to organic whole foods. Meta-analysis demonstrates that providing supplements such as Vitamin D, etc. and reducing simple carbohydrates and sugars and eating more vegetables, fruits and healthy fats during regular meals can ameliorate the symptoms and promote health.
The previous article and blog, Reflections on the increase in Autism, ADHD, anxiety and depression: Part 1-bonding, screen time, and circadian rhythms, pointed out how the changes in bonding, screen time and circadian rhythms affected physical and mental health (Peper, 2023a; Peper, 2023b). However, there are many additional factors including genetics that may contribute to the increase is ADHD, autism, anxiety, depression, allergies and autoimmune illnesses (Swatzyna et al., 2018). Genetics contribute to the risk of attention deficit hyperactivity disorder (ADHD); since, family, twin, and adoption studies have reported that ADHD runs in families (Durukan et al., 2018; Faraone & Larsson, 2019). Genetics is in most cases a risk factor that may or may not be expressed. The concept underlying this blog is that genetics loads the gun and environment and behavior pulls the trigger as shown in Figure 1.
Figure 1. Interaction between Genetics and Environment
The pandemic only escalated trends that already was occurring. For example, Bommersbach et al (2023) analyzed the national trends in mental health-related emergency department visits among USA youth, 2011-2021. They observed that in the USA, Over the last 10 years, the proportion of pediatric ED visits for mental health reasons has approximately doubled, including a 5-fold increase in suicide-related visits. The mental health-related emergency department visits increased an average of 8% per year while suicide related visits increased 23.1% per year. Similar trends have reported by Braghieri et al (2022) from the National Survey on Drug Use and Health as shown in Figure 2.
Figure 2. Mental health trends in the United States by age group in 2008–2019. The data come from the National Survey on Drug Use and Health. Reproduced with permission from Braghieri, Luca and Levy, Ro’ee and Makarin, Alexey, Social Media and Mental Health (July 28, 2022) https://ssrn.com/abstract=3919760 or http://dx.doi.org/10.2139/ssrn.3919760
The trends reported from this data shows an increase in mental health illnesses for young people ages 18-23 and 24-29 and no changes for the older groups which could be correlated with the release of the first iPhone 2G on June 29, 2007. Thus, the Covid 19 pandemic and social isolation were not THE CAUSE but an escalation of an ongoing trend. For the younger population, the cellphone has become the vehicle for personal communication and social connections, many young people communicate more with texting than in-person and spent hours on screens which impact sleep (Peper, 2023a). At the same time, there are many other concurrent factors that may contributed to increase of ADHD, autism, anxiety, depression, allergies and autoimmune illnesses.
Without ever signing an informed consent form, we all have participated in lifestyle and environmental changes that differ from that evolved through the process of evolutionary natural selection and promoted survival of the human species. Many of those changes in lifestyle are driven by demand for short-term corporate profits over long-term health of the population. As exemplified by the significant increase in vaping in young people as a covert strategy to increase smoking (CDC, 2023) or the marketing of ultra-processed foods (van Tulleken, 2023).
This post focusses how pesticides and herbicides (exposure to neurotoxins) and changes in our food negatively affects our health and well-being and is may be another contributor to the increase risk for developing ADHD, autism, anxiety and depression. Although our food may look and even taste the same compared to 50 years ago, it is now different–more herbicide and pesticide residues and is often ultra-processed. lt contains lower levels of nutrients and vitamins such as Vitamin C, Vitamin B2, Protein, Iron, Calcium and Phosphorus than 50 years ago (Davis et al, 2004; Fernandez-Cornejo et al., 2014). Non-organic foods as compared to organic foods may reduce longevity, fertility and survival after fasting (Chhabra et al., 2013).
Being poisoned by pesticide and herbicide residues in food
Almost all foods, except those labeled organic, are contaminated with pesticides and herbicides. The United States Department of Agriculture reported that “Pesticide use more than tripled between 1960 and 1981. Herbicide use increased more than tenfold (from 35 to 478 million pounds) as more U.S. farmers began to treat their fields with these chemicals” (Fernandez-Cornejo, et al., 2013, p 11). The increase in herbicides and pesticides is correlated with a significant deterioration of health in the United States (Swanson, et al., 2014 as illustrated in the following Figure 3.
Figure 3. Correlation between Disease Prevalence and Glyphosate Applications (reproduced with permission from Swanson et al., 2014.
Although correlation is not causation and similar relationships could be plotted by correlating consumption of ultra-refined foods, antibiotic use, decrease in physical activity, increase in computer, cellphone and social media use, etc.; nevertheless, it may suggest a causal relationship. Most pesticides and herbicides are neurotoxins and can accumulate in the person over time this could affect physical and mental health (Bjørling-Poulsen et al., 2008; Arab & Mostaflou, 2022). Even though the United States Environmental Protection Agency (EPA) has determined that the residual concentrations in foods are safe, their long-term safety has not been well established (Leoci & Ruberti, 2021). Other countries, especially those in which agribusiness has less power to affect legislation thorough lobbying, and utilize the research findings from studies not funded by agribusiness, have come to different conclusions…
For example, the USA allows much higher residues of pesticides such as, Round-Up, with a toxic ingredient glyphosate (0.7 parts per million) in foods than European countries (0.01 parts per million) (Wahab et al., 2022; EPA, 2023; European Commission, 2023) as is graphically illustrated in figure 4.
Figure 4: Percent of Crops Sprayed with Glyphosate and Allowable Glyphosate Levels in the USA versus the EU
The USA allows this higher exposure than the European Union even though about half of the human gut microbiota are vulnerable to glyphosate exposure (Puigbo et al., 2022). The negative effects most likely would be more harmful in a rapidly growing infant than for an adult. Most likely, some individuals are more vulnerable than others and are the “canary in mine.” They are the early indicators for possible low-level long-term harm. Research has shown that fetal exposure from the mother (gestational exposure) is associated with an increase in behaviors related to attention-deficit/hyperactivity disorders and executive function in the child when they are 7 to 12 years old (Sagiv et al., 2021). Also, organophosphate exposure is correlated with ADHD prevalence in children (Bouchard et al., 2010). We hypothesize this exposure is one of the co-factors that have contributed to the decrease in mental health of adults 18 to 29 years.
At the same time as herbicides and pesticides acreage usage has increased, ultra-processed food have become a major part of the American diet (van Tulleken, 2023). Eating a diet high in ultra-processed foods, low in fiber, high sugar, animal fats and additives has been associated with higher levels of inattention and hyperactivity in children with ADHD; namely, high consumption of sugar, candy, cola beverages, and non-cola soft drinks and low consumption of fatty fish were also associated with a higher prevalence of ADHD diagnosis (Ríos-Hernández et al., 2017).
In international studies, less nutritional eating behaviors were observed in ADHD risk group as compared to the normal group (Ryu et al., 2022). Artificial food colors and additives are also a public health issue and appear to increase the risk of hyperactive behavior (Arnold et al., 2012). In a randomized double-blinded, placebo controlled trial 3 and 8/9 year old children had an increase in hyperactive behavior for those whose diet included extra additives (McCann et al., 2007). The risk may occur during fetal development since poor prenatal maternal is a critical factor in the infants neurodevelopment and is associated with an increased probability of developing ADHD and autism (Zhong et al., 2020; Mengying et al., 2016).
Poor nutrition even affects your unborn grandchild
Poor nutrition not only affects the mother and the developing fetus through epigenetic changes, it also impacts the developing eggs in the ovary of the fetus that can become the future granddaughter (Wilson, 2015). At birth, the baby has all of her eggs. Thus, there is a scientific basis for the old wives tale that curses may skip a generation. Providing maternal support is even more important since it affects the new born and the future grandchild. The risk may even begin a generation earlier since the grandmother’s poor nutrition as well as stress causes epigenetic changes in the fetus eggs. Thus 50% of the chromosomes of the grandchild were impacted epigenetically by the mother’s and grandmother’s dietary and health status .
Highly processed foods
Highly refined foods have been processed to remove many of their nutrients. These foods includes white bread, white rice, pasta, and sugary drinks and almost all the fast foods and snacks. These foods are low in fiber, vitamins, and minerals, and they are high in sugars, unhealthy fats, and calories. In addition, additives may have been added to maximize taste and mouth feel and implicitly encourage addiction to these foods. A diet high in refined sugars and carbohydrates increases the risk of diabetes and can worsen the symptoms of ADHD, autism, depression, anxiety and increase metabolic disease and diabetes (Woo et al., 2014; Lustig, 2021; van Tulleken, 2023). Del-Ponte et al. (2019) noted that a diet high in refined sugar and saturated fat increased the risk of symptoms of ADHD, whereas a healthy diet, characterized by high consumption of fruits and vegetables, would protect against the symptoms.
Most likely, a diet of highly refined foods may cause blood sugar to spike and crash, which can lead to mood swings, irritability, anxiety, depression and cognitive decline and often labeled as “hangryness” (the combination of anger and hunger) (Gomes et al., 2023; Barr et al., 2019). At the same time a Mediterranean diet improves depression significantly more than the befriending control group (Bayles et al., 2022). In addition, refined foods are low in essential vitamins and minerals as well as fiber. Not enough fiber can slow down digestion, affect the human biome, and makes it harder for the body to absorb nutrients. This can lead to nutrient deficiencies, which can contribute to the symptoms of ADHD, autism, depression, and anxiety. Foods do impact our mental and physical health as illustrated by foods that tend to reduce depression (LaChance & Ramsey, 2018; MacInerney et al., 2017). By providing appropriate micronutrients such as minerals (Iron, Magnesium Zinc), vitamins (B6, B12, B9 and D), Omega 3s (Phosphatidylserine) and changing our diet, ADHD symptoms can be ameliorated.
Many children with ADHD, anxiety, depression are low on essential vitamins and minerals. For example, low levels of Omega-3 fatty acids and vitamin D may be caused by eating ultra-refined foods, fast foods, and drinking soft drink. At the same time, the children are sitting more in indoors in front of the screen and thereby have lower sun exposure that is necessary for the vitamin D production.
“Because of lifestyle changes and sunscreen use, about 42% of Americans are deficient in vitamin D. Among children between 1 to 11 years old, an estimated 15% have vitamin D deficiency. And researchers have found that 17% of adolescents and 32% of young adults were deficient in vitamin D.” (Porto and Abu-Alreesh, 2022).
Reduced sun exposure is even more relevant for people of color (and older people); since, their darker skin (increased melanin) protects them from ultraviolet light damage but at the same time reduces the skins production of vitamin D. Northern Europeans were aware of the link between sun exposure and vitamin D production. To prevent rickets (a disease caused by vitamin D deficiency) and reduce upper respiratory tract infections the children were given a tablespoon of cod liver oil to swallow (Linday, 2010). Cod liver oil, although not always liked by children, is more nutritious than just taking a Vitamin D supplements. It is a whole food and a rich source of vitamin A and D as well as containing a variety of Omega 3 fatty acids (eicosapentaenoic acid (EPA) (USDA, 2019).
Research studies suggest that ADHD can be ameliorated with nutrients, and herbs supplements (Henry & CNS, 2023). Table 1 summarizes some of the nutritional deficits observed and the reduction of ADHD symptoms when nutritional supplements were given (adapted from Henry, 2023; Henry & CNS, 2023).
| Nutritional deficits observed in people with ADHD | Decrease in ADHD symptoms with nutritional supplements |
| Vitamin D: In meta-analysis with a total number of 11,324 children, all eight trials reported significantly lower serum concentrations of 25(OH)D in patients diagnosed with ADHD compared to healthy controls. (Kotsi et al, 2019) | After 8 weeks children receiving vitamin D (50,000 IU/week) plus magnesium (6 mg/kg/day) showed a significant reduction in emotional problems as observed in a randomized, double blind, placebo-controlled clinical trial (Hemamy et al., 2021). |
| Iron: In meta-analysis lower serum ferritin was associated with ADHD in children (Wang et al., 2017) and the mean serum ferritin levels are lower in the children with ADHD than in the controls (Konofal et al., 2004). | After 12 weeks of supplementation with Iron (ferrous sulfate) in double-blind, randomized placebo-controlled clinical trial, clinical trials symptoms of in children with ADHD as compared to controls were reduced (Tohidi et al., 2021; Pongpitakdamrong et all, 2022). |
| Omega 3’s: Children with ADHD are more likely to be deficient in omega 3’s than children without ADHD (Chang et al., 2017). | Adding Omega-3 supplements to their diet resulted in an improvement in hyperactivity, impulsivity, learning, reading and short term memory as compared to controls in 16 randomized controlled trials including 1514 children and young adults with ADHD (Derbyshire, 2017) |
| Magnesium: In meta-analysis, subjects with ADHD had lower serum magnesium levels compared with to their healthy controls (Effatpahah et al., 2019) | 8 weeks of supplementation with Vitamin D and magnesium caused a significant decrease in children with conduct problems, social problems, and anxiety/shy scores (Hemamy et al., 2020). |
| Vitamin B2, B6, B9 and B12deficiency has been found in many patients with Attention Deficit and Hyperactivity Disorder (Landaas et al, 2016; Unal et al., 2019). | Vitamin therapy appears to reduce symptoms of ADHD and ASD (Poudineh et al., 2023; Unal et al., 2019). An 8 weeks supplementing with Vitamin B6 and magnesium decreased hyperactivity and hyperemotivity/aggressiveness. When supplementation was stopped, clinical symptoms of the disease reappeared in few weeks (Mousain-Bosc et al., 2006). |
Table 1. Examples of vitamin and mineral deficiencies associated with symptoms of ADHD and supplementation to reduction of ADHD symptoms.
Supplementation of vitamins and minerals in many cases consisted of more than one single vitamin or mineral. For an in-depth analysis and presentation, see the superb webinar by Henry & CNS (2023): https://divcom-events.webex.com/recordingservice/sites/divcom-events/recording/e29cefcae6c1103bb7f3aa780efee435/playback? (Henry & CNS, 2023).
Whole foods are more than the sum of individual parts (the identified individual constituents/nutrients). The process of digestion is much more complicated than ingesting simple foods with added vitamins or minerals. Digestion is the interaction of many food components (many of which we have not identified) which interact and affect the human biome. A simple added nutrient can help; however, eating whole organic foods it most likely be healthier. For example, whole-wheat flour is much more nutritious. Whole wheat is rich in vitamins B-1, B-3, B-5, riboflavin, folate well as fiber while refined white flour has been bleached and stripped of fiber and nutrients to which some added vitamins and iron are added.
Recommendation
When working with clients, follow Talib’s principles as outlined in Part 1 by Peper (2023) which suggests that to improve health first remove the unnatural which in this case are the ultra-processed foods, simple carbohydrates, exposure to pesticides and herbicides (Taleb, 2014). The approach is beneficial for prevention and treatment. This recommendation to optimize health is both very simple and very challenging. The simple recommendation is to eat only organic foods and as much variety as possible as recommended by Professor Michael Pollan in his books, Omnivore’s Dilemma: A Natural History of Four Meals and Food Rules (Pollan, 2006; Pollan, 2011).
Do not eat foods that contain herbicides and pesticide residues or are ultra-processed. Although organic foods especially vegetable and fruits are often much more expensive, you have choice: You can pay more now to optimize health or pay later to treat disease. Be safe and not sorry. This recommendation is similar to the quote, “Let food be thy medicine and medicine be thy food,” that has been attributed falsely since the 1970s to Hippocrates, the Greek founder of western medicine (5th Century, BC) (Cardenas, 2013).
There are many factors that interfere with implementing these suggestions; since, numerous people live in food deserts (no easy access to healthy unprocessed foods ) or food swamps (a plethora of fast food outlets) and 54 million Americans are food insecure (Ney, 2022). In addition, we and our parents have been programmed by the food industry advertising to eat the ultra- processed foods and may no longer know how to prepare healthy foods such as exemplified by a Mediterranean diet. Recent research by Bayles et al (2022) has shown that eating a Mediterranean diet improves depression significantly more than the befriending control group. In addition, highly processed foods and snacks are omnipresent, often addictive and more economical.
Remember that clients are individuals and almost all research findings are based upon group averages. Even when the data implies that a certain intervention is highly successful, there are always some participants for whom it is very beneficial and some for whom it is ineffective or even harmful. Thus, interventions need to be individualized for which there is usually only very limited data. In most cases, the original studies did not identify the characteristics of those who were highly successful or those who were unsuccessful. In addition, when working with specific individuals with ADHD, anxiety, depression, etc. there are multiple possible causes.
Before beginning specific clinical treatment such as neurofeedback and/or medication, we recommend the following:
- “Grandmother assessment” that includes and assessment of screen time, physical activity, outdoor sun exposure, sleep rhythm as outlined in Part 1 by Peper (2023). Then follow-up with a dietary assessment that investigates the prevalence of organic/non organic foods, ingestion of fast foods, ultra-processed foods, soft drinks, high simple carbohydrate and sugar, salty/sugary/fatty snacks, fruits, vegetables, and eating patterns (eating with family or by themselves in front of screens). Be sure to include an assessment of emotional reactivity and frequency of irritability and “hangryness”.
- If the assessment suggest low level of organic whole foods and predominance of ultra- refined foods, it may be possible that the person is deficient in vitamins and minerals. Recommend that the child is tested for the vitamin deficiencies. If vitamin deficiencies identified, recommend to supplement the diet with the necessary vitamins and mineral and encourage eating foods that naturally include these substances (Henry & CNS, 2023). If there is a high level of emotional reactivity and “hangryness,” a possible contributing factor could be hypoglycemic rebound from a high simple carbohydrate (sugar) intake or not eating breakfast combined with hyperventilation (Engel et al., 1947; Barr et al., 2019). Recommend eliminating simple carbohydrate breakfast and fast food snacks and substitute organic foods that include complex carbohydrates, protein, fats, vegetables and fruit. Be sure to eat breakfast.
- Implement “Grandmother Therapy”. Encourage the family and child to change their diet to eating a whide variety of organic foods (vegetables, fruits, some fish, meat and possibly dairy) and eliminate simple carbohydrates and sugars. This diet will tend to reduce nutritional deficits and may eliminate the need for supplements.
- Concurrent with the stabilization of the physiology begin psychophysiological treatment strategies such as neurofeedback biofeedback and cognitive behavior therapy.
Relevant blogs
Author Disclosure
Authors have no grants, financial interests, or conflicts to disclose.
References
Arnold, L, Lofthouse, N., & Hurt, E. (2012). Artificial food colors and attention-deficit/hyperactivity symptoms: conclusions to dye for. Neurotherapeutics, 9(3), 599-609. https://doi.org/10.1007/s13311-012-0133-x
Arab, A. & Mostafalou, S. (2022). Neurotoxicity of pesticides in the context of CNS chronic diseases. International Journal of Environmental Health Research, 32(12), 2718-2755. https://doi.org/10.1080/09603123.2021.1987396
Barr, E.A., Peper, E., & Swatzyna, R.J. (2019). Slouched Posture, Sleep Deprivation, and Mood Disorders: Interconnection and Modulation by Theta Brain Waves. NeuroRegulation, 6(4), 181–189. https://doi.org/10.15540/nr.6.4.181
Bayes. J., Schloss, J., Sibbritt, D. (2022). The effect of a Mediterranean diet on the symptoms of depression in young males (the “AMMEND: A Mediterranean Diet in MEN with Depression” study): a randomized controlled trial. Am J Clin Nutr. 116(2), 572-580. https://doi.org/10.1093/ajcn/nqac106
Bjørling-Poulsen, M., Andersen, H.R. & Grandjean, P. Potential developmental neurotoxicity of pesticides used in Europe. Environ Health 7, 50 (2008). https://doi.org/10.1186/1476-069X-7-50
Bommersbach, T.J., McKean, A.J., Olfson, M., Rhee, T.G. (2023). National Trends in Mental Health–Related Emergency Department Visits Among Youth, 2011-2020. JAMA, 329(17):1469–1477. https://doi.org/10.1001/jama.2023.4809
Bouchard, M.F., Bellinger, D.C., Wright, R.O., & Weisskopf, M.G. (2010). Attention-deficit/hyperactivity disorder and urinary metabolites of organophosphate pesticides. Pediatrics, 125(6), e1270-7. https://doi.org/10.1542/peds.2009-3058
Braghieri, L., Levy, R., & Makarin, A. (2022). Social Media and Mental Health (July 28, 2022). Available at SSRN: https://ssrn.com/abstract=3919760 or http://dx.doi.org/10.2139/ssrn.3919760
Cardenas, D. (2013). Let not thy food be confused with thy medicine: The Hippocratic misquotation. e-Spen Journal, 8(6), 3260-3262. https://doi.org/10.1016/j.clnme.2013.10.002
CDC, (2023). Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults. CDC. Centers for Disease Control and Prevention. Accessed September 23, 2023. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html
Chang, J.C., Su, K.P., Mondelli, V. et al. Omega-3 Polyunsaturated Fatty Acids in Youths with Attention Deficit Hyperactivity Disorder: a Systematic Review and Meta-Analysis of Clinical Trials and Biological Studies. Neuropsychopharmacol. 43, 534–545. https://doi.org/10.1038/npp.2017.160
Chhabra, R., Kolli, S., & Bauer, J.H. (2013). Organically Grown Food Provides Health Benefits to Drosophila melanogaster. PLoS ONE, 8(1): e52988. https://doi.org/10.1371/journal.pone.0052988
Davis, D. R., Epp, M. D., & Riordan, H. D. (2004). Changes in USDA food composition data for 43 garden crops, 1950 to 1999. Journal of the American College of Nutrition, 23(6), 669-682. https://doi.org/10.1080/07315724.2004.10719409
Derbyshire, E. (2017). Do Omega-3/6 Fatty Acids Have a Therapeutic Role in Children and Young People with ADHD? J Lipids. 6285218. https://doi.org/10.1155/2017/6285218
Del-Ponte, B., Quinte, G.C., Cruz, S., Grellert, M., & Santos, I. S. Dietary patterns and attention deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis. Journal of Affective Disorders, 252, 160-173. https://doi.org/10.1016/j.jad.2019.04.061
Durukan, İ., Kara, K., Almbaideen, M., Karaman, D., & Gül, H. (2018). Alexithymia, depression and anxiety in parents of children with neurodevelopmental disorder: Comparative study of autistic disorder, pervasive developmental disorder not otherwise specified and attention deficit-hyperactivity disorder. Pediatrics International, 60(3), 247–253. https://doi.org/10.1111/ped.13510
Effatpanah, M., Rezaei, M., Effatpanah, H., Effatpanah, Z., Varkaneh, H.K., Mousavi. S.M., Fatahi, S., Rinaldi, G., & Hashemi, R. (2019). Magnesium status and attention deficit hyperactivity disorder (ADHD): A meta-analysis. Psychiatry Res, 274, 228-234. https://doi.org/10.1016/j.psychres.2019.02.043
Engel, G.L., Ferris, E.B., & Logan, M. (1947). Hyperventilation; analysis of clinical symptomatology. Ann Intern Med, 27(5), 683-704. https://doi.org/10.7326/0003-4819-27-5-683
EPA. (2023). Glyphosate. United States Environmental Protection Agency. Accessed April 1, 2023. https://www.epa.gov/ingredients-used-pesticide-products/glyphosate
European Commission. (2023). EU legislation on MRLs.Food Safety. Assessed April 1, 2023. https://food.ec.europa.eu/plants/pesticides/maximum-residue-levels/eu-legislation-mrls_en#:~:text=A%20general%20default%20MRL%20of,e.g.%20babies%2C%20children%20and%20vegetarians
Faraone, S.V. & Larsson, H. (2019). Genetics of attention deficit hyperactivity disorder. Mol Psychiatry, 24(4), 562-575. https://doi.org/10.1038/s41380-018-0070-0
Fernandez-Cornejo, J. Nehring, R, Osteen, C., Wechsler, S., Martin, A., & Vialou, A. (2014). Pesticide use in the U.S. Agriculture: 21 Selected Crops, 1960-2008. Economic Information Bulletin Number 123, United State Department of Agriculture. https://www.ers.usda.gov/webdocs/publications/43854/46734_eib124.pdf
Gomes, G. N., Vidal, F. N., Khandpur. N., et al. (2023). Association Between Consumption of Ultraprocessed Foods and Cognitive Decline. JAMA Neurol, 80(2),142–150. https://doi.org/10.1001/jamaneurol.2022.4397
Hemamy, M., Heidari-Beni, M., Askari, G., Karahmadi, M., & Maracy, M. (2020). Effect of Vitamin D and Magnesium Supplementation on Behavior Problems in Children with Attention-Deficit Hyperactivity Disorder. Int J Prev Med, 11(1), 4. https://doi.org/10.4103/ijpvm.IJPVM_546_17
Henry, K. (2023). An Integrative Medicine Approach to ADHD. Rupa Health. Accessed September 30, 2023. https://www.rupahealth.com/post/an-integrative-medicine-approach-to-adhd
Henry, K. & CNS, L.A. (2023). Natural treatments for ADHD. Webinar Presentation by IntegrativePractitioner.com and sponsored by Rupa Health, June 6, 2023 https://divcom-events.webex.com/recordingservice/sites/divcom-events/recording/e29cefcae6c1103bb7f3aa780efee435/playback?
Hemamy, M., Pahlavani, N., Amanollahi, A. et al. (2021). The effect of vitamin D and magnesium supplementation on the mental health status of attention-deficit hyperactive children: a randomized controlled trial. BMC Pediatr, 21, 178. https://doi.org/10.1186/s12887-021-02631-1
Konofal, E., Lecendreux, M., Arnulf, I., & Mouren, M. (2004). Iron Deficiency in Children With Attention-Deficit/Hyperactivity Disorder. Arch Pediatr Adolesc Med, 158(12), 1113–1115. https://doi.org/10.1001/archpedi.158.12.1113
Kotsi, E., Kotsi, E. & Perrea, D.N. (2019). Vitamin D levels in children and adolescents with attention-deficit hyperactivity disorder (ADHD): a meta-analysis. ADHD Atten Def Hyp Disord, 11, 221–232. https://doi.org/10.1007/s12402-018-0276-7
LaChance, L.R. & Ramsey, D. (2018). Antidepressant foods: An evidence-based nutrient profiling system for depression. World J Psychiatr, 8(3): 97-104. World J Psychiatr., 8(3): 97-104. https://doi.org/10.5498/wjp.v8.i3.97
Landaas, E.T., Aarsland, T.I., Ulvik, A., Halmøy, A., Ueland. P.M., & Haavik, J. (20166). Vitamin levels in adults with ADHD. BJPsych Open, 2(6), 377-384. https://doi.org/10.1192/bjpo.bp.116.003491
Linday, L.A. (2010). Cod liver oil, young children, and upper respiratory tract infections. J Am Coll Nutr, 29(6), 559-62. https://doi.org/10.1080/07315724.2010.10719894
Leoci, R. & Ruberti, M. (2021) Pesticides: An Overview of the Current Health Problems of Their Use. Journal of Geoscience and Environment Protection, 9, 1-20. https://doi.org/10.4236/gep.2021.98001
Lustig, R.H. (2021). Metaboical: The lure and the lies of processed food, nutrition, and modern medicine. New York: Harper Wave. https://www.amazon.com/Metabolical-processed-poisons-people-planet/dp/1529350077
MacInerney, E. K., Swatzyna, R. J., Roark, A. J., Gonzalez, B. C., & Kozlowski, G. P. (2017). Breakfast choices influence brainwave activity: Single case study of a 12-year-old female. NeuroRegulation, 4(1), 56–62. https://doi.org/10.15540/nr.4.1.56
McCann, D., Barrett, A., Cooper, A., Crumpler, D., Dalen, L., Grimshaw, K., et al. (2007). Food additives and hyperactive behavior in 3-year old and 8/9-year-old children in the community: a randomized, double-blinded, placebo-controlled trial. Lancet, 370(9598), 1560-1567. https://doi.org/10.1016/S0140-6736(07)61306-3
Mengying, L.I, Fallin, A, D., Riley,A., Landa, R., Walker, S.O., Silverstein, M., Caruso, D., et al. (2016). The Association of Maternal Obesity and Diabetes With Autism and Other Developmental Disabilities. Pediatrics, 137(2), e20152206. https://doi.org/10.1542/peds.2015-2206
Mousain-Bosc, M., Roche, M., Polge, A., Pradal-Prat, D., Rapin, J., & Bali, J.P. (2006). Improvement of neurobehavioral disorders in children supplemented with magnesium-vitamin B6. I. Attention deficit hyperactivity disorders. Magnes Res. 19(1), 46-52. https://pubmed.ncbi.nlm.nih.gov/16846100/#:~:text=In%20almost%20all%20cases%20of,increase%20in%20Erc%2DMg%20values.
Ney, J. (2022). Food Deserts and Inequality. Social Policy Data Lab. Updated: Jan 24, 2022. Accessed September, 23, 2023. https://www.socialpolicylab.org/post/grow-your-blog-community
Peper, E. (2023a). Reflections on the increase in Autism, ADHD, anxiety and depression: Part 1-bonding, screen time, and circadian rhythms. the peperperspective July 2, 2023. Accessed august 8, 2024, https://peperperspective.com/2023/07/04/reflections-on-the-increase-in-autism-adhd-anxiety-and-depression-part-1-bonding-screen-time-and-circadian-rhythms/
Peper, E. (2023b). Reflections on the increase in Autism, ADHD, anxiety and depression: Part 1-bonding, screen time, and circadian rhythms. NeuroRegulation, 10(2), 134-138. https://doi.org/10.15540/nr.10.2.134
Pollan, M. (2006). Omnivore’s Dilemma: A Natural History of Four Meals and Food Rules. New York Penguin Press. https://www.amazon.com/Omnivores-Dilemma-Natural-History-Meals/dp/1594200823/ref=tmm_hrd_swatch_0?_
Pollan, M. (2011). Food rules. New York Penguin Press. https://www.amazon.com/Food-Rules-Eaters-Michael-Pollan/dp/B00VSBILFG/ref=tmm_hrd_swatch_0?
Pongpitakdamrong, A., Chirdkiatgumchai, V., Ruangdaraganon, N., Roongpraiwan, R., Sirachainan, N., Soongprasit, M., & Udomsubpayakul, U. (2022). Effect of Iron Supplementation in Children with Attention-Deficit/Hyperactivity Disorder and Iron Deficiency: A Randomized Controlled Trial. Journal of Developmental & Behavioral Pediatrics, 43(2), 80-86., https://doi.org/10.1097/DBP.0000000000000993
Porto, A. & Abu-Alreesh, S. (2022). Vitamin D for babies, children & adolescents. Health Living. Healthychildren.org. Accessed September 24, 2023. https://www.healthychildren.org/English/healthy-living/nutrition/Pages/vitamin-d-on-the-double.aspx#
Poudineh, M., Parvin, S., Omidali, M., Nikzad, F., Mohammadyari, F., Sadeghi Poor Ranjbar, F., F., Nanbakhsh, S., & Olangian-Tehrani, S. (2023). The Effects of Vitamin Therapy on ASD and ADHD: A Narrative Review. CNS & Neurological Disorders – Drug Targets (Formerly Current Drug Targets – CNS & Neurological Disorders), (22), 5, 2023, 711-735. https://doi.org/10.2174/1871527321666220517205813
Puigbò, P., Leino, L. I., Rainio, M. J., Saikkonen, K., Saloniemi, I., & Helander, M. (2022). Does Glyphosate Affect the Human Microbiota?. Life, 12(5), 707. https://doi.org/10.3390/life12050707
Ríos-Hernández, A., Alda, J.A., Farran-Codina, A., Ferreira-García, E., & Izquierdo-Pulido, M. (2017). The Mediterranean Diet and ADHD in Children and Adolescents. Pediatrics, 139(2):e20162027. https://doi.org/10.1542/peds.2016-2027
Ryu, S.A., Choi, Y.J., An, H., Kwon, H.J., Ha, M., Hong, Y.C., Hong, S.J., & Hwang, H.J. (2022). Associations between Dietary Intake and Attention Deficit Hyperactivity Disorder (ADHD) Scores by Repeated Measurements in School-Age Children. Nutrients, 14(14), 2919. https://doi.org/10.3390/nu14142919
Sagiv, S.K., Kogut, K., Harley, K., Bradman, A., Morga, N., & Eskenazi, B. (2021). Gestational Exposure to Organophosphate Pesticides and Longitudinally Assessed Behaviors Related to Attention-Deficit/Hyperactivity Disorder and Executive Function, American Journal of Epidemiology, 190(11), 2420–2431. https://doi.org/10.1093/aje/kwab173
Swanson, N.L., Leu, A., Abrahamson, J., & Wallet, B. (2014). Genetically engineered crops, glyphosate and the deterioration of health in the United States of America. Journal of Organic Systems, 9(2), 6-17. https://www.organic-systems.org/journal/92/JOS_Volume-9_Number-2_Nov_2014-Swanson-et-al.pdf
Swatzyna, R. J., Boutros, N. N., Genovese, A. C., MacInerney, E. K., Roark, A. J., & Kozlowski, G. P. (2018). Electroencephalogram (EEG) for children with autism spectrum disorder: Evidential considerations for routine screening. European Child & Adolescent Psychiatry, 28(5), 615–624. https://doi.org/10.1007/s00787-018-1225-x
Taleb, N. N. (2014). Antifragile: Things That Gain from Disorder (Incerto). New York: Random House Publishing Group. https://www.amazon.com/Antifragile-Things-That-Disorder-Incerto/dp/0812979680/ref=tmm_pap_swatch_0
Tohidi, S., Bidabadi, E., Khosousi, M.J., Amoukhteh, M., Kousha, M., Mashouf, P., Shahraki, T. (2021). Effects of Iron Supplementation on Attention Deficit Hyperactivity Disorder in Children Treated with Methylphenidate. Clin Psychopharmacol Neurosci, 19(4), 712-720. https://doi.org/10.9758/cpn.2021.19.4.712
Unal, D. Çelebi, F., Bildik,H.N., Koyuncu, A., & Karahan, S. (2019). Vitamin B12 and haemoglobin levels may be related with ADHD symptoms: a study in Turkish children with ADHD, Psychiatry and Clinical Psychopharmacology, 29(4), 515-519. https://doi.org/10.1080/24750573.2018.1459005
USDA. (2019). Fish oil, cod liver. FoodData Central. USDA U.S> Department of Agriculture. Published 4/1/2019. Accessed September 24, 2024. https://fdc.nal.usda.gov/fdc-app.html#/food-details/173577/nutrients
Van Tulleken, C. (2023). Ultra-Processed People. The Science Behind Food That Isn’t Food. New York: W.W. Norton & Company. https://www.amazon.com/Ultra-Processed-People-Science-Behind-Food/dp/1324036729/ref=asc_df_1324036729/?
Wahab, S., Muzammil, K., Nasir, N., Khan, M.S., Ahmad, M.F., Khalid, M., Ahmad, W., Dawria, A., Reddy, L.K.V., & Busayli, A.M. (2022). Advancement and New Trends in Analysis of Pesticide Residues in Food: A Comprehensive Review. Plants (Basel), 11(9), 1106. https://doi.org/10.3390/plants11091106
Wang. Y., Huang, L., Zhang, L., Qu, Y., & Mu, D. (2017). Iron Status in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. PLoS One, 12(1):e0169145. https://doi.org/10.1371/journal.pone.0169145
Wilson, L. (2015). Mothers, beware: Your lifestyle choices will even affect your grandkids.
News Corp Australia Network. Accessed Jun 24, 2024. https://www.news.com.au/lifestyle/parenting/kids/mothers-beware-your-lifestyle-choices-will-even-affect-your-grandkids/news-story/3f326f457546cfb32af5c409f335fb56
Woo, H.D.,; Kim, D.W., Hong, Y.-S., Kim, Y.-M.,Seo, J.-H.,; Choe, B.M., Park, J.H.,; Kang, J.-W., Yoo, J.-H.,; Chueh, H.W., et al. (2014). Dietary Patterns in Children with Attention Deficit/Hyperactivity Disorder (ADHD). Nutrients, 6, 1539-1553. https://doi.org/10.3390/nu6041539
Zhong, C., Tessing, J., Lee, B.K., Lyall, K. Maternal Dietary Factors and the Risk of Autism Spectrum Disorders: A Systematic Review of Existing Evidence. Autism Res,13(10),1634-1658. https://doi.org/10.1002/aur.2402
Evolutionary approach to return to health
Posted: July 20, 2016 Filed under: Uncategorized | Tags: ADHD, biofeedback, circadian rhythm, depression, epilepsy, evolution, neurofeedback 2 CommentsMany illness may be prevented or reversed when we life in harmony with our evolutionary origins such as diet, movement, and circadian rhythm. The focus is to teach skills and not pills; since, many medications have long term negative side affects. By applying behavioral life style changes that supports our evolutionary patterns, we may be able to prevent or even reverse numerous illnesses such as epilepsy, eczema, diabetes, Crohn’s disease, allergies, ADHD, depression, anxiety, cancer, stress related symptoms.
Enjoy the wide ranging lecture presented at the 2012 meeting of the International Society for Neurofeedback and Research.
A historical perspective of neurofeedback: Video interview by Larrry Berkelhammer of Erik Peper
Posted: January 18, 2015 Filed under: Uncategorized | Tags: biofeedback, cancer, electroencephalography, health, neurofeedback, self-regulation 1 CommentDr. Erik Peper is interviewed by Dr. Larry Berkelhammer about the research he did in the late 60s and early 70s on EEG alpha training. He describes how he learned to turn off alpha brain rhythms in one hemisphere and turn them on in the other.
Neurofeedback equipment allows researchers and clinicians to get extremely useful feedback, allowing people who are hooked up to get very good at identifying their own brain rhythms and to alter them at will. This can potentially allow us to re-train our brains. Dr. Peper talks about how the real gift of science is about being open to explore rather than to assume our beliefs are factual. Science is about curiosity, experimentation, and exploration. In studying people with cancer and other diseases it is vital that we study more than just pathology–we need to study those individuals who are the outliers, that is, those who recovered against all odds–let’s see what they did to mobilize their health.
Support Healthy Brain Development*
Posted: April 11, 2014 Filed under: Evolutionary perspective, Uncategorized | Tags: ADHD, brain development, child development, computers, evolution, medication, neurofeedback 2 CommentsFactors that support brain development and contribute to the possible development of ADD/ADHD is the focus of my recently article, Support Healthy Brain Development: Implications for Attention Deficit/ Hyperactivity Disorder, published in Psychophysiology Today,9(1), 4-15. The article takes an evolutionary perspective of development and suggests that our lifestyle interacting with the digital devices has implications for our health. This blog extracts some parts of the published article. For the complete article with references see: http://biofeedbackhealth.files.wordpress.com/2014/04/support-healthy-brain-development-psychophysiology-today.pdf
In class, he fidgets, every auditory and visual stimulus distracts him– he gets up, talks to other students and disrupts the class. Nothing seems to hold his attention, he looks at the page and moments later turns around and disturbs the boy behind him. At home, he grabs his food and leaves the table. He is continuously distracted. The only thing that seems to capture his attention is his computer games.
ADD/ADHD has become an epidemic in the last 30 years. Now one in seven boys by the time they reach the age of 18 have received this diagnosis according to the Centers for Disease Control and Prevention, as shown in Figure 1.
Figure 1. Rate of office-based visits per 1000 US population aged 5 through 18 with diagnosis (Dx) of ADHD and rate of use of medication (Rx) for boys and girls. Redrawn from: Sclar, D. A., Robison, L. M., Bowen, K. A., Schmidt, J. M., Castillo, L. V., & Oganov, A. M. (2012). Attention-Deficit/Hyperactivity Disorder among Children and Adolescents in the United States Trend in Diagnosis and Use of Pharmacotherapy by Gender. Clinical pediatrics, 51(6), 584-589.
The increase in ADD/ ADHD diagnoses cannot be explained by genetics alone. It may depend upon the interaction of genetics and the environment. It may develop into a disorder as a result of disrespecting and not understanding our evolutionary background during our development. We attempt remedy them with medications (e.g., Adderall, Concerta and Ritalin) that provide an 8 billion dollar revenue stream for pharmaceutical companies. Yet, there is little or no evidence of long term benefits. Self-mastery approaches such as Neurofeedback have demonstrated long term benefits in improving reading, writing, and mathematical scores as well as decreasing impulsive behavior. Neurofeedback training teaches children how to control their brain function.
Our modern lifestyle has compromised the healthy development of the brain and behavior. To prevent this we need to support those factors that during the course of evolution increased survival, reproductive fitness and promoted healthy brains.
1) Breast feed children at least for one year and concurrently introduce new foods slowly after 6 or 8 months to reduce the risk of developing food allergies.
2) Respect the importance of face-to-face contact to provide safety, develop empathy and nurture social connection.
3) Encourage motor development such as crawling, playing in nature, and physical movement that occurs while playing games support brain development instead sitting and being entertained by smartphones, computers, tablets or TV screens. Physical movement during play– without being distracted by the overwhelming rapid changing stimuli shown on LED and TV screens–is necessary for brain development.
4) Reestablish circadian (daily) rhythms. Until the 19th century our biological and activity rhythms were controlled by natural light. It is hard to imagine not having light at night to read. When the sun went down, we went to sleep. Light not only illuminates, it affects our physiology by regulating our biological rhythms by blocking melatonin production which interferes with sleep.
5. Support touch and movement with vision and sound to develop the brain. During the first years of life, the baby/toddler integrates the visual and auditory world with touch and movement. Motor development is the underpinning of brain development..
6. Provide constancy and reduce novelty. When reading a bedtime story, the child wants to hear the same story again and again. If part of the story is skipped, the child interrupts and reminds us to read correctly. When the child is stressed, it wants to hear a past story for comfort and safety. Repetition while feeling safe allows memory to create appropriate neural connections. Neural growth depends upon the appropriate level and type of stimuli.Too few stimuli hinders brain development and too many novel stimuli may decrease brain development.
7. Limit hours of watching or playing computer games that trigger orienting and activation. The rapidly changing visual stimuli from these screens evokes the biological reflexes to attend– there is something new and it could be safe, dangerous or life threatening. The physiological processes and the important implications for health and illness have been elucidated by the polyvagal theory developed by Professor Stephen Porges.
Over-stimulation with digital devices has been associated with impaired learning and decreased ability to self-regulate. The flood of novel visual and auditory stimuli trains the brain to react, to react again, and again. The ongoing external novelty captures the child’s attention, instead of directing attention from within.
8. Provide face to face safety as infants begin to explore the world. In the last 50 years we have radically increased the visual and auditory input to a developing baby following the concept of more is better. Babies are now exposed to visual and auditory stimuli which rapidly pass by them without repetition or the ability to interact kinesthetically with them. Babies are often carried on the chest or in baby carriages/strollers facing forward- leading the charge into the unknown–instead of receiving face-to-face reassurance from the parent, touching the parent, or hiding behind the parent for safety.
In a study of 2722 observations of parent-child pairs by developmental psychologist Dr Suzanne Zeedyk, parents talked twice as much to their baby when it faced them than when the baby was facing forward in the stroller. The impact of stress was measured by the decrease in baby laughing. Babies who faced their mother/caretaker while being pushed laughed 90% more than those who faced forward. As babies become older they do want to face the environment as it is more interesting; however, when the infants feel overwhelmed or threatened there is an opportunity to automatically reconnect with the caretaker to feel safe.
In summary, do not park children in front of smart phones, tablets, computer games, and television screens that flood the auditory and visual senses without the ability to integrate the information through touch and movement. Although TV and computer games are superb baby sitters, it is not the same as interacting and playing with a baby and toddler to develop the appropriate motor and emotional control. Let’s create an environment that is in harmony with our evolutionary background–An environment where infants play interactively with objects, explore nature and have face-to-face contact with their caregiver.
Even if the initial conditions during growing up were less than optimum, the brain can change—a process known as neuroplasticity. Thus, nurture inner directed attention by having the child develop skill mastery. Learning these skills can include neurofeedback training, back-to-nature explorations, learning to play a musical instrument, practicing a sport or martial art technique, or participating in yoga and meditation. These and many other practices will change the neural structure: it is never too late to learn, change, and optimize health.
To view or download the whole article with references: http://biofeedbackhealth.files.wordpress.com/2014/04/support-healthy-brain-development-psychophysiology-today.pdf
*I thank Drs. Stephen Porges, Linda Thompson, Michael Thompson, Monika Fuhs, and Annette Booiman for their constructive feedback.
Epilepsy: New (old) treatment without drugs
Posted: March 10, 2013 Filed under: Nutrition/diet, self-healing, Uncategorized | Tags: biofeedback, diet, ketogenic diet, neurofeedback 11 CommentsNothing is so hard as watching a child having a seizure.
–Elizabeth A. Thiele, MD, PhD, professor of neurology at Harvard Medical School
Until recently, when people asked me, “What would I suggest as a non-toxic/non-invasive biofeedback approach for the treatment of epilepsy?” I automatically replied, “A combination of neurofeedback, behavioral analysis treatment, respiration training, a low glycemic diet, and stress management and if these did not work, medications.” I have now changed my mind!
Epilepsy is diagnosed if the person has two or more seizures. About one to two percent of the population is diagnosed with epilepsy and it is the most common neurological illness in children. Medication is usually the initial treatment intervention; however, in about one third of the people, the seizures will still occur despite the medications. In some cases, people -often without the support of their neurologist/healthcare provider–will explore other treatment strategies such as diet, respiration training, neurofeedback, behavioral control, diet, or traditional Chinese medicine.
It is ironic that one of the tools to diagnose epilepsy is recording the electroencephalography (EEG)– brain waves–of the person after fasting while breathing quickly (hyperventilating). For some, the combination of low blood sugar and hyperventilation will evoke epileptic wave forms in their EEG and can trigger seizures (hyperventilation when paired with low sugar levels tends to increase slow wave EEG which would promote seizure activity).
If hyperventilation and fluctuating blood sugar levels are contributing factors in triggering seizures, why not teach breathing control and diet control as the first non-toxic clinical intervention before medications are prescribed. This breathing approach has shown very promising clinical success. (For more details see the book, Fried, R. (1987). The Hyperventilation syndrome-Research and Clinical Treatment. Baltimore: The Johns Hopkins University Press).
Self-management should be the first clinical intervention and not the last. Similarly, neurofeedback– brain wave biofeedback–is another proven approach to reduce seizures. This approach was developed by Professor Maurice B. Sterman at UCLA and was based upon animal studies. He demonstrated that cats who were trained to increase sensory motor rhythm (SMR) in their EEG could postpone seizure onset when exposed to a neurotoxin that induced seizures. He then demonstrated that human beings with epilepsy could equally learn to control their EEG patterns and inhibit seizures. This approach, just as the breathing approach, is non-toxic and reduces seizures.
Underlying both these approaches is the concept of behavioral analysis to identify and interrupt the chained behavior that leads to a seizure. Namely, a stimulus (internal or external) triggers a cascading chain of neurological processes that eventually results in a seizure. Thus, if the person learns to identify and interrupt/divert this cascading chain, the seizure does not occur. From this perspective, respiration training and neurofeedback could be interpreted to interrupt this cascading process. Behavioral analyses includes all behaviors (movement, facial expressions, emotions, etc) which can be identified and then interrupted. As professors Joanne Dahl and Tobias Lundgren from Uppsala University in Sweden state, The behavior technology of seizure control provides low-cost, drug free treatment alternative for individual already suffering from seizures and the stigmatization of epilepsy.
Until recently, I would automatically suggest that people explore these self-control strategies as the first intervention in treatment of epilepsy and only medication for the last resort. Now, I have changed my mind. I suggest the ketogenic diet as the first step for the treatment of epilepsy in conjunction with the self-regulation strategies—medication should only be used if the previous strategies were unsuccessful.
A ketogenic diet has a 90% clinical success rates in children–even in patients with refractory seizures. This diet stabilizes blood sugar levels and is very low on simple carbohydrates, high in fat, some protein, and lots of vegetables (a ratio of 4 grams of fat to 1 gram of carbohydrates and protein). In adults, the success rates drops to about 50%. The lower success rate may be the result of the challenges in implementing these self-regulatory diet approaches. As Elizabeth A. Thiele, MD, PhD, professor of neurology at Harvard Medical School points out, dietary therapy is the most effective known treatment strategy for epilepsy. Even though, ketogenic diet is the most effective therapy, it is less likely to be prescribed than medications—there are no financial incentives; there are, however, many financial incentives for prescribing pharmaceuticals.
These lifestyle changes are very challenging to implement. They need to be taught and socially supported. Just telling people what to do does not often work. It is similar to learning to play a musical instrument. The person needs step by step coaching and social support which is an intensive educational approach. To learn more about the research underlying the ketogenic diet as the first level of intervention for epilepsy, watch Professor Thiele’s presentation from the 2012 Ancentral Health Symposium, Dietary Therapy: Role in Epilepsy and Beyond.
There is hope for neurological recovery: Redirect behaviors of habit
Posted: February 23, 2013 Filed under: self-healing, Uncategorized | Tags: behavior analysis, Cerebral palsy, epilepsy, habit, neurofeedback, rehabilitation, stroke Leave a commentAlthough many neurological disorders appear to be structural and the result of neurological dysfunctioning, recent research suggests that there is much more hope that people can learn to restore function. Even people affected by stroke, cerebral palsy, or epilepsy can regain function. The observed symptoms and dysfunctional movement patterns can be understood as the nervous system’s best strategy to solve a problem at that moment and is the best response the person could perform under the circumstances. For example in the case of stroke, a spastic movement is the best solution that becomes a conditioned habit pattern. It may occur because the person tries to achieve the previous motor behaviors which can no longer be performed because of the neurological damage. With cerebral palsy, the initial damage at birth changed the motor patterns as the child attempted to walk. While in cases of epilepsy, the spreading of the seizure across the brain is not inhibited. Despite the neurological damage, improvement is possible as demonstrated by Jill Bolte Taylor’s presentation of her experience and remarkable recovery from a left hemisphere stroke.
Application to stroke rehabilitation
A useful premise underlying neural regeneration and development is that it healing follows developmental movement sequences which cannot be skipped. Thus after a neurological injury such as a stroke, the movement sequence needs to be re-integrated. It is not relearning what was lost; it is learning the new skills as if the skills are being learned for the first time. This includes an attitude of acceptance, non judgment, fun, play and exploration concurrent with many, many, many training practices until the skills are mastered. Thus stroke patients sitting in wheelchairs may try to repeat movements which were present before the stroke but which are now beyond the biological developmental stage due to the neural damage. The person instead needs to learn anew the movement sequences that a baby mastered (lifting the head, rolling over, cross crawl moment, crawling, etc). This takes lots of practice. Compare the many hours a baby/child practices in order to be able to stand to the limited time people with strokemay spent performing their prescriptive exercises. Thus, children usually show mastery while many people with stroke demonstrate limited improvement. It is practice, practice and practice; it is not mindless practice, it is practice with awareness and intent.
Dysfunctional patterns can be understood as over learned conditioned chained behaviors which occur automatically. A superb explanation of this process is described by Charles Duhigg in his book, The power of habit-Why we do what we do in life and business. Clinical success is to identify these chains and the sequential steps and then teach the person to redirect the behavior.
Application to epilepsy
Some people with epilepsy can learn to identify the initiation of the seizure and then interrupt the cascading sequence by doing something different. In this way the seizure process is interrupted and no seizure will occur. For example, one man hyperventilated before a grand mal seizure. When the therapist taught him to become aware and change his breathing pattern each he began to hyperventilate, his epileptic seizures did not occur. Similarly, a young woman with epilepsy turned her head to the right and slightly lifted her chin upward just before an absence seizure occurred. Teaching her to interrupt her initial head movement and looking straight ahead while slowly exhaling inhibited her seizures. The efficacy of this type of behavioral analysis for the treatment of epilepsy has been described by psychologists, Joanne Dahl, PhD and Tobias Lundgren, PhD in their superb article, Behavior analysis of epilepsy: Conditioning mechanisms, behavior technology and the contribution of ACT.
Another powerful treatment approach to treat seizures was developed by M. B. Sterman, Ph.D. at UCLA who taught people with epilepsy to control their own electrical activity of their brain with neurofeedback. Many people benefited from neurofeedback training and significantly reduced their seizures.
Application to cerebral palsy
To appreciate the power of interrupting the chained behaviors and the possibility that there is hope for people with cerebral palsy. This is illustrated in the remarkable TEDx Winnepeg talk, Baby brains DO recover, but habit hides it, by Karen Pape, MD.
the peper perspective 