Bedwetting ADHD Kids and Depressed Dads: Is there a connection?

ADHD and Bedwetting (Nocturnal Enuresis): How are the two related?

There is a relatively recent publication that came out within the last couple of weeks on the relatively high rate of occurrence in bed wetting (enuresis) among ADHD children, which I believe is worth sharing. We have previously investigated this ADHD and bed wetting connection (note that bed wetting may be more likely to be seen alongside the inattentive subtype of ADHD). However, this study offers some additional insight into this strange association between the two disorders. Here are some important points worth mentioning:

• Overlapping Drug Treatment for ADHD and bedwetting: It stands to reason that if a particular drug or agent is effective in treating multiple disorders, there may be a distinct possibility that those two or more disorders may share some type of underlying cause(s) or defect(s). For example, Tofranil or Imipramine, a drug used to treat enuresis and depressive disorders can possibly be useful as a treatment option for ADHD. We have also investigated the potential role of Reboxetine as a potential ADHD treatment in previous entries. Some work has found Reboxetine to be useful in treating therapy-resistant enuresis as well.

• Prevalence of Enuresis in ADHD: Enuresis refers to urinary incontinence which is limited to the night-time. Additionally, the term is typically limited to individuals over the age of 5 (i.e. a 3-year-old child who frequently pees in their pants would not be considered as suffering from enuresis, at least in the context of this study). The article cites other studies in which the rate of bedwetting (enuresis) in ADHD is as high as 30%, although other studies have it down around 10-20%. Still, compared to the general population, (factoring in things such as the age of the child, of course)the high rate of bed wetting in ADHD is especially noteworthy. There is some evidence from other studies that ADHD and enuresis may be more intricately linked than previously imagined. For example, one particular study has shown that treating urinary incontinence has a higher rates of failure in children with ADHD vs. non-ADHD children.
  
  
• The role of Oppositional Defiant Disorder (ODD) on Bed wetting: The study examine several different psychiatric disorders which frequently occur alongside of (or are comorbid to) ADHD. These include depression, anxiety disorders, obsessive compulsive disorders, tic disorders, nail biting, bruxism (teeth grinding), conduct disorders and oppositional defiant disorders. However, out of all of these different disorders which often appear alongside ADHD, the only one which exhibited a statistically significant correlation to increases in bedwetting was oppositional defiant disorder. Interestingly, oppositional defiant disorders have been associated with bedwetting in other ADHD studies.
  
  As its name suggests, Oppositional Defiant Disorder is a disorder in which a child exhibits disobedience, irritability and hostility towards authority figures beyond the range of normal age-appropriate behaviors. Of course there is a significant gray area with regards to what is age appropriate, especially when the child's environment is considered. Nevertheless, Oppositional Defiant Disorder (or ODD) is much more than just routine temper tantrums. Oppositional Defiant Disorders may also be associated with auditory processing issues and ADHD. It is somewhat interesting that anxiety disorders, which have also been correlated to oppositional behaviors, did not elicit a significant positive correlation to bed wetting.
  
  
• The autonomic nervous system as a potential underlying cause of ADHD, bedwetting and Oppositional Defiant Disorders: The autonomic nervous system is the part of the nervous system responsible for involuntary muscle actions such as digestive processes, blood vessel contraction, etc. It is subdivided into the sympathetic and parasympathetic nervous systems, which often act in a sort of "push-pull" opposition to each other. For example, the sympathetic nervous system does things such as boosting heart rate and constricting blood vessels, while the parasympathetic nervous system is in charge of activities such as reducing heart rates and relaxing sphincter muscles (which plays a role in bladder control).
  
  Typically, the sympathetic and parasympathetic components of the nervous system are kept in balance, but this balance may be thrown out of whack and result in numerous disorders. For example, it is believed that the parasympathetic nervous system is over dominant in cases of Oppositional Defiant Disorders (ODD). The study found that for ADHD and Oppositional Defiant Disordered children, functions such as heart rate were controlled excessively (if not almost exclusively) by the parasympathetic portion of the nervous system (while non-ODD and non-ADHD children had both sympathetic and parasympathetic controls operating on their heart rates. This suggests a common underlying imbalance among the different components of the nervous system which is common to ADHD and ODD individuals and often separates them from the non-ADHD'ers. Interestingly, other studies have indicated that bedwetting or generalized incontinence problems may also be caused by an overactive parasympathetic nervous system, which suggests that ADHD, ODD and night-time bedwetting may all share some underlying causes within the nervous system.

• Connection to Parental Depression: I personally found this observation to be interesting. The study found that the prevalence of bedwetting in ADHD children was higher if the father (but not the mother) of the child was suffering from some sort of major depressive illness. The article did not express an opinion as to whether these depressive symptoms were due in part to the child's bed wetting problems or whether there was some underlying mechanism at work.

• ADHD medications may Influence Enuresis: The authors highlight some other works in which popular ADHD medications may either increase or decrease the risk of bedwetting in ADHD children. For example, the article highlighted a case study (by the same author) in which treatment with methylphenidate induced nocturnal enuresis. Methylphenidate is one of the most common ADHD drugs, and often goes by the common trade names Ritalin, Concerta, Metadate and Daytrana (the patch form of the drug). Of course this is based on only one individual case, but for those of you who have read this blog on a frequent basis, will know that I like to report on some of these abnormal occurrences (for reference sake, here is an earlier blog post I have done on the possible connection between methylphenidate and excessive talking. While based on an isolated case report, I believe that this zany potential side effect was at least worth a mention). On the flip side, however, the non-stimulant alternative ADHD drug, Atomoxetine (Strattera) can be a useful treatment for enuresis. This blogger would personally like to see additional studies on whether ADHD children with a comorbid bedwetting condition actually saw a better reduction in their ADHD symptoms while on Strattera than while on methylphenidate. If this were the case, then bedwetting may actually served as a useful tip-off as to which type of ADHD medication would work best for that particular child.

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Beauty Find: Enhance your Body With Makeup

Not so happy with your body? Maybe want fuller breasts or a six-pack for the abs? It appears, you can achieve it all using some smart makeup!Just recently I stumbled upon It Cosmeticsline that offers special makeup kits that help to sex you up in a matter of minutes. With the vacation season approaching, looking good in that bikini becomes one of the burning issues. So what if you could get a

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Beauty Review: Clarins Eclat Minute Instant Light Eye Perfecting Base

Promise:Facilitates make-up application and promotes lasting wearPackaging:Comes in a convenient pen with a brushShade:Clarins Eclat Minute is available in only one shade 00 which is very light pink with beige undertonesApplication:You can apply Clarins Instant Light Eye Perfecting Base on the eye lid using the brush it comes with. Very convenient to get close to eye lashes or reach the eye

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How to find symptoms of Gonorrhea

Symptoms of Gonorrhea can truly be seen fast, if you are aware of that. These things are not going to be unnoticed for too long and if you observe symptoms you are going to support up and see a doctor. If you do not see a doctor and you see symptoms than it will be a blunder from your side.

You have to have a need to be cautious for yourself if you think you have something wrong in your body. Most likely these symptoms symbolize themselves early on with little discharges. If you see an abnormal discharge from your genitals, then you need urgently go to the doctor. In other cases, dealing with Symptoms of Gonorrhea generally means pain. If you see ulcers, experience pain, or have something wrong with your sexual parts, you actually need to think again about yourself. If you have, in recent times, had unprotected sex, you actually should get yourself protection and go see your doctor. Sometimes sexually transmitted diseases can be treated without argument with your way.

1 in 5 people have Symptoms of Gonorrhea today. The author of this blog is fully dedicated to provide the maximum information to people in order to make awareness among them.

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Penicillin-Resistant Gonorrhea in the Philippines

Counting the present series of Gonorrhea cases in Philippines, there are more than 362 reported cases of penicillin-resistant cases of gonorrhea in the Philippines. Early reports of isolated cases of Gonorrhea came from Southeast Asia.

In the current study, isolates are from hospitality girls or escorts who came from Olongapo City and Angeles City to take benefit of the International Monetary Fund Meeting and the opening of the big hotels in Manila. These girls have had sexual contact with American servicemen at the US bases and do not respond to presently recommended dosage of penicillin.

Simultaneously, studies made on the effectiveness and tolerance of two alternative antibiotic regimens namely: cotrimoxazole quicksolv forte double strength and tetracycline. This study showed that cotrimoxazole quicksolv forte given at 2 day treatment timetable is more adequate than the l-day schedule and much better than the single dose regimen of tetracycline (2.5 gm).

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Discount on Sustainable Youth Products for Skin Care and Beauty Blog Readers

Lovely ladies! Great news! Sustainable Youth is offering you a discount of 10% on all Sustainable Youth products (except for Sustainable Youth kit). This is an additional discount on top of the special “Stimulus Pricing” running on their site currently!Just enter this code Intro10skincarebeautyproduct at the check out. This offer expires on the 30th of June. You still have plenty of time to read

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Strattera (Atomoxetine) response may be affected by SLC6A2 gene

About a month ago, we were discussing the ADHD gene SLC6A2. Located on the 16th human chromosome, different variations of this SLC6A2 gene are believed to play at least somewhat of a determining factor as to the genetic predisposition towards attention deficit hyperactivity disorders (ADHD). We saw that this gene was also correlated to anxiety and depression-like symptoms (which commonly occur along many ADHD patients) and that these genetic factors were slightly stronger in girls.

Atomoxetine (Strattera) is a non-stimulant alternative to medication treatment for ADHD. Unlike most stimulant medications, which interfere and regulate the pathways of the neurotransmitter dopamine, atomoxetine acts upon the pathway of the neuro-signaling agent norepinephrine. While dopamine-related stimulant medications for ADHD can worsen accompanying anxiety and depressive-like disorders (extreme caution is necessary when prescribing stimulants if a severe co-illness of anxiety or depression is present alongside ADHD), Strattera has shown to extremely beneficial in the co-treatment of depressive-like illnesses, especially when used alongside the SSRI class of antidepressant drugs.

A recent publication in the journal Neuropsychopharmacology highlights the potential connection between variations of the "ADHD gene" SLC6A2 and the effectiveness Strattera (Atomoxetine) for treating ADHD.

It is important to remember that for most genes, there are slight variations in the different forms within the human population. For most, these small changes in DNA do not result in any major physiological differences, but for some, even a change of one or two units of DNA can make a huge impact on biological functions, such as response to a specific medication. We have previously discussed how both the Catechol O-Methyltransferase (COMT) and CREM genes, may both dictate different dosing levels for ADHD medications.

Based on the SLC6A2 and Strattera study, it appears that individuals with specific gene variations of the SLC6A2 gene had a significantly more positive response to atomoxetine (based on a common behavioral rating process typically used to assess ADHD and related disorders), than were others with different variations of the gene. These effects were seen even when another gene (the CYP2D6 gene, located on the 22nd human chromosome and is responsible for the metabolism of atomoxetine/Strattera) was taken into account.

We will hopefully discuss these findings in more detail later, but the main point to drive home from all of this is the concept of how individual gene variation (i.e., which specific forms of a particular gene one has), can play a major role in predicting whether:

1. An individual will even respond to particular drug (such as Strattera for ADHD), and
2. Whether that individual's particular forms of these genes predispose him or her to requiring a higher (or lower) than normal dosage level than otherwise physiologically similar individuals to achieve the desired effects.

This blogger personally believes that we have just begun to scratch the surface in investigating the power of gene-medication interactions, and how these interactions will shape the landscape for ADHD treatment.

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Beauty Buzz: New Sisley Perfume Eau de Sisley 1, 2 & 3

Sisley unlike many other brands rolling out new perfumes every year or even every other month, Sisley takes its own slow pace and releases a new fragrance every 10-15 years. I am under a strong impression that if Sisley launches something, it is genius and has taken years of development. In one of the interviews Hubert d'Ornano, founder/owner of the brand said "We launch when we have something

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Beauty Review: Mavala Cuticle Cream

Promise: Softens the skin surrounding the nail providing a neat and cared for nail contourWhat’s Inside:Lanolin, Petrolatum, Water, Mineral Oil, Alcohol Denat, Metyhylparaben, Butylparaben, Chlorphenesin, Triclosan, Ethylparaben, Propylparaben, Fragrance, Linalool, Hydroxycitronellal, Citronellol, Hexyl Cinnamaldehyde, 2-Propionaldehyde, Coumarin, Geraniol etc.As I can see it includes some

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Phenylketonuria (PKU) or ADHD?

ADHD vs. Phenylketonuria: A possible misdiagnosis?

If you’ve never heard or seen the term phenylketonuria (PKU) before, you are not alone. However, here’s a quick experiment. Go look at the back of a 2-Liter bottle of diet soda. Near the bottom of the back label, you will probably see a small warning label that says something along the line of “Phenylketonurics: contains phenylalanine” (individuals with phenylketonuria are often referred to as phenylketonurics).

The reason that this warning is on the back of only diet sodas and not regular ones is because the artificial sweetener Aspartame (Nutrasweet) contains the amino acid phenylalanine as one of its two primary components. When phenylketonurics, take in large amounts of this artificial sweetener, they get a large buildup of this amino acid in their bloodstream which they have trouble clearing. As a result, they often suffer a number of physiological problems, in, but not limited to, the nervous system.


The conversion process of phenylalanine to dopamine and how it relates to ADHD:

Phenylketonurics are those individuals who, for typically genetically predetermined reasons, are unable to break down and process the amino acid phenylalanine. This process actually has several implications that can relate to ADHD. We have spoken extensively about the neurochemical dopamine in various other posts. In general, chemical imbalances of this important neurotransmitter are frequently at the helm of ADHD and related disorders (typically shortages of dopamine are found in the "gaps" between neuronal cells, and most stimulant medications for ADHD work by resetting dopamine levels within these gaps). As we can see below, the body can actually manufacture this important brain chemical from various sources or starting materials, including phenylalanine (providing that the individual is capable of manufacturing all of the necessary enzymes in the conversion process. For PKU patients, this conversion process is hindered, and typically leads to shortages of dopamine). A rough sketch of the conversion process is listed below:

So what’s the point?

I have highlighted the chemical changes above, using different colors to represent the enzymes used and the chemical changes that these enzymes are responsible for (note the red and blue colors). As we can see above, the first step of the metabolism of phenylalanine to dopamine is done by adding a hydroxyl ("OH") group to phenylalanine, converting it to another amino acid, tyrosine. The chemical change is highlighted in red. (As an interesting side note, tyrosine is sometimes used as an ADHD supplement or auxiliary to medication treatment, even though the effectiveness of tyrosine for treating ADHD is questionable. Note that if one with PKU were to start with tyrosine, they would bypass the step of the chemical process of converting phenylalanine to tyrosine, which would help with the deficient enzyme phenylalanine hydroxylase. This enzyme will be addressed further down in the post).

Further modifications carry it to the product dopamine, which require two other enzymes (as a side note, the conversion of tyrosine to dopamine, in addition to the two enzymes listed above, also requires an adequate supply of iron. This is one reason why maintaining ample iron stores is necessary in combating ADHD and related disorders, and why an iron deficiency can elicit some of the negative behaviors characteristic of ADHD patients). As an aside, we have previously investigated how iron deficiency can affect both ADHD and sleep disorders and how iron supplementation can potentially offset the toxic effects of lead in ADHD patients.

You'll notice that the first step of the conversion process is blocked for individuals with PKU. This is due to a mutation in the gene that codes for this enzyme, the phenylalanine hydroxylase gene. For reference sake, the phenylalanine hydroxylase gene is located on 12th human chromosome. Remember that it is the mutated form(s) of the gene that can lead to PKU, the vast majority of the human population carries the regular form.

Fortunately, phenylketonuria is a rare genetic disorder, affecting less than one percent of the population. This is due, in part, to the fact that it must be present in both parents to be passed on to a child. It is almost always detected in most newborn screenings. However, it is possible to be missed, especially if a milder form is present. While there are several key differences, some of its symptoms mimic problems that correlate with attention deficit disorders. These include:

• Hyperactivity
• Erratic Arm and Leg Movements (can be similar to tics or Tourette's-like behavior, which often accompanies ADHD individuals as a comorbid disorder)
• Social immaturity and impairment of mental skills
• Learning disabilities

As we can see, these four traits are classic behaviors seen in many children diagnosed with ADHD. The first two are more characteristic of the hyperactive/impulsive or combined subtypes of ADHD, the fourth is more tied to the inattentive form of the disorder, and the third can fall into any of the categories. Interestingly, both ADHD and PKU disorders share a common brain region of deficit, the prefrontal cortex.

Key Differences Between ADHD and PKU:

• IQ: Most individuals with ADHD typically fall within the normal range on most IQ tests (however, cases of abnormally high or low IQ scores certainly exist). For individuals with PKU, however, a depressed IQ is almost always seen (PKU is a relatively common cause of mental retardation). For example, in a British study, it was found that IQ scores for children with PKU hovered around 90. The IQ scores were closely correlated to the ability of the individual treatments to keep the phenylalanine levels below a specific benchmark in the blood. In addition, differences in subscores, indicate a possible deficit in spatial processing. Interestingly, visual-spatial deficits are often present in ADHD and its comorbid disorders as well.
  
  
• Head size: Abnormally small head sizes are often seen in PKU. While smaller relative volumes in specific brain regions are often seen in ADHD, the overall head size differences are typically not as pronounced as for PKU. Interestingly, the effects of smaller head sizes and brain regions for both PKU and ADHD, respectively found the differences to be much more pronounced in boys than in girls. Note that we have previously discussed several other gender differences in ADHD.
  
  
• Onset of symptoms: In general, PKU symptoms are fully manifested in the first two years of life. These include both mental and physical impairments. While symptoms of ADHD can often begin to appear early on, they often do not fully appear until much later in life. As a result, difficulties in pinning down age-specific aspects of ADHD persist.

As we can see, there are a number of features and methods in place such that the possibility of misdiagnosing ADHD as PKU and PKU as ADHD by a skilled professional is relatively small. However, in addition to PKU, there are genetic deficiencies which result in compromised activity of the phenylaline hydroxylase enzyme by around 5 to 10%. While these deficiencies are milder than in full-fledged phenylketonuria, it does bring up a critical point that intermediate states do exist between being diagnosed with PKU and not having PKU. It is possible that individuals in this potentially vulnerable intermediate state of enzyme deficiency may be more susceptible to disorders such as ADHD. Of course, this is just a personal hypothesis.

Nevertheless, the main goal of this post was to highlight some of the key genetic, physiological and behavioral overlaps of the two disorders. It is my personal belief that looking for common underlying trends between even the most disparate disorders can offer a wealth of information into some of the underlying causes of the individual disorders that we would otherwise miss. In other words, I think we often sell our selves short by not digging "deep" enough in our investigations of the fundamental causes of diseases and disorders such as ADHD and phenylketonuria.

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Makeup Tip: Defining Eyebrows

Just came across an easy tip from Bobbi Brown for natural looking defined eyebrows.Photo by Julianne.Hide at flickr.comChoose a shade matching your natural brow color. Brush your brows down, this way you will see the line to fill in. Fill in white spaces using selected color with a brow brush/pencil. Blend. Now just brush your brows upwards again and the correction line won’t be noticeable.Check

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How PID take place in women due to Gonorrhea

PID comes about at the moment when some bacteria move up from a woman's vagina or cervix (opening to the uterus) into her reproductive organs. A lot of different organisms can be a reason of PID, but many cases of PID are associated with Gonorrhea and Chlamydia, two very common bacterial STDs (Sexually Transmitted Diseases). A prior occurrence of PID increases the risk of an additional episode because the reproductive organs may be damaged during the first session of infection.

Sexually energetic women in their initial puberty years are most at risk, and those under age 26 are more likely to build up PID than those older than 26. This is partially for the reason that the cervix of teenage girls and young women is not completely matured, rising their susceptibility to the STDs that are linked to PID.

The added sex partners a woman has, the bigger her risk of PID. In addition, a woman whose sexual partner has more than one sex partner is at higher risk of developing PID, for the reason that of the potential for more exposure to infectious agents.

Women who douche may have a higher risk of developing PID judge against women who do not douche. Examinations have shown that douching changes the vaginal flora (living organisms in the vagina) in destructive ways, and can force microorganisms into the upper reproductive organs from the vagina.

PID is increasing rapidly in these states of USA; New York, New Jersey, Los Angeles.

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Beauty Fact: Red Enhances Men's Attraction To Women

Now we have one more reason to wear red lipstick. And this time it’s scientifically supported!A study by two University of Rochester psychologists looked at a relationship between color and behavior. It was revealed that the color red makes men feel more attracted to women.In the course of the study researchers analyzed men’s responses to photographs of women under a variety of color

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How common is PID in USA

Every year in the United States, it is predictable that more than 1 million women and girls experience an incident of sensitive PID (Pelvic Inflammatory Disease).

More than 103,000 women as well as teenage girls become unproductive or infertile every year as a result of PID, and a huge proportion of the ectopic pregnancies (when the childbirth take place in fallopian tubes) occurring each year are due to the results of PID.

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PID (Pelvic inflammatory disease) in Women due to Gonorrhea

Pelvic inflammatory disease (PID) is a common term that refers to infection of the fallopian tubes (tubes that carry eggs from the ovaries to the uterus), uterus (womb) and other reproductive organs of females.

It is a widespread and serious problem of some sexually transmitted diseases (STDs), particularly Gonorrhea and Chlamydia. PID can damage the fallopian tubes and tissues in and near the uterus and ovaries. PID (Pelvic inflammatory disease) can lead to serious results including ectopic pregnancy (when a pregnancy takes place in the fallopian tube or elsewhere outside of the womb), infertility, chronic pelvic pain, and abscess formation.

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Cefixime 400 mg Tablets for Gonorrhea treatment

The only present CDC-recommended options for the treatment of gonorrhea or Neisseria gonorrhoeae infections are from a single group of antibiotics, “The Cephalosporins”.

Within this group of medications:

1. Only Ceftriaxone is available as an injection, is the CDC recommended cure for all types of gonorrhea infections (i.e. rectal, urogenital, and pharyngeal).

2. The only oral agent currently recommended by CDC for treatment of simple urogenital or rectal gonorrhea is one dose of cefixime 400 mg. Availability of cefixime had been inadequate since July 2002, at what time Wyeth Pharmaceuticals (Collegeville, Pennsylvania) stop manufacturing cefixime tablets in the United States of America. In April 2008, cefixime (Suprax®) 400 mg tablets are again obtainable in the United States.

Source: www.cdc.gov

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Beauty Buzz: YSL Makeup Collection Summer 2009

YSL's summer collection was inspired by the bright contrasting colors and exoticism of Africa.Complexion:* LIMITED EDITION Trésor d'Afrique Collector Sun Powder - bronzer with golden shimmer to give your face a sun-kissed lookEyes:* LIMITED EDITION Trésor d'Afrique 5 Colour Collector Palette for the Eyes* New Fard Lumière Aquarésistant Water Resistant Cream Eyeshadow * LIMITED EDITION Everlong

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10 Ways Carnitine can help treat ADHD

Carnitine: The missing link to omega-3 supplementation for ADHD

Carnitine is one of the new "trendy" supplements out there today, due in part to the number of heart-healthy benefits that can be derived from it's usage (often alongside other new popular supplements such as Coenzyme Q10). I am not here to discourage these supplements, I definitely see a number of positives from taking them, but for this post I would like to address the topic on Carnitine and ADHD: Can Carnitine, with all of it's heart-healthy benefits, actually be useful in treating ADHD? Here are 10 possible reasons why carnitine may be a powerful new treatment option for ADHD and related disorders:

As a quick aside: Carnitine, like many other nutrients, can exist in different forms, one of which is acetylcarnitine. This form, actually has a number of metabolic roles, but for the sake of simplicity, I will not go into too much detail about the different forms of carnitine unless absolutely necessary.

1. Potential for boosting the effectiveness of omega-3 fatty acid supplementation: We have already discussed the theory and applications of omega-3's and their possible benefits as alternative non-pharmaceutical treatment options for ADHD. Nonetheless, despite the recent surge in population of omega-3's (including the ever-popular fish oil supplements), only marginal amounts of improvements as far as behavior and symptom reductions are often seen. A big possibility for this limited effectiveness may actually stem from missing pieces of the puzzle with regards to omega-3 metabolism. This may include a deficiency in carnitine. There is even some speculation that abnormalities in fatty acid metabolism may play a role in autism, and that carnitine levels may play a role in this. Given the degree of inter-relationship between autism and ADHD, this possible connection may be at least worth mentioning. In particular, carnitine plays an important role in the synthesis of the docosahexaenoic acid (DHA), and a carnitine deficiency can result in a reduction of this key nutrient. Like several other important fatty acids, DHA deficency is often seen in ADHD individuals.
   


2. Carnitine may be beneficial for "refractory" ADHD (unresponsive to conventional pharmaceutical treatment): This one is somewhat surprising. Typically supplementation and "natural" measures can be tried, but if they fail, the more "heavy-hitting" pharmaceutical treatment options for ADHD are often employed. However, a Dutch study done by Van Oudheusden and Scholte which investigated the efficacy of carnitine in treating children with ADHD mentioned that carnitine was found to be effective in treating ADHD in children who were previously unresponsive to methylphenidate, clonidine or behavioral therapy treatments.
   
   What's interesting is that this group found a strong connection between plasma carnitine levels and a reduction in behavior problems (i.e., those children who were able to build up higher levels of carnitine in the blood were more likely to show direct benefit with regards to ADHD symptoms, while those with lower blood levels exhibited more severe ADHD-like behavior). This strongly suggests the carnitine/ADHD connection and also highlights the fact that there is a relatively wide degree of variation among individuals as far as carnitine storage and metabolism is concerned. Even more interesting, this same group found that when carnitine treatment was discontinued, the negative ADHD symptoms re-appeared relatively soon (within 3-4 weeks), but upon re-administration of the previous carnitine doses, the behavioral problems quickly subsided again.
   


3. Potential for use for both inattentive and hyperactive/impulsive ADHD: The same study on carnitine treatment for ADHD noted that a decrease in aggression and conduct problems (which are often comorbid to or co-occur with the more hyperactive/impulsive side of ADHD) upon treatment with carnitine. Not to be outdone, another study found that carnitine was more useful in treating the inattentive subtype of ADHD. Interestingly, the inattentive ADHD study found that individuals with the combined subtype ADHD subtype (which includes high levels of both the inattentive and hyperactive/impulsive behaviors) actually showed a worsening of symptoms upon treatment with carnitine.
   
   It's important to note that the Dutch study did see some improvement in inattentive symptoms as well, so it appears (at least for now), that carnitine may be more of benefit towards treating the inattentive aspects of ADHD. This may actually be in line with other studies which link carnitine treatment to increased energy (individuals with the inattentive form of ADHD are often more likely associated to be more lethargic as opposed to the bouncing-off-the-walls behavior typically exhibited by the hyperactive/impulsive or combined ADHD subtypes).


4. Carnitine as a memory booster: I am personally hesitant to suggest supplementation with generalized memory boosters for ADHD (multiple ADHD websites love to do this), due to the distinct nature of the disorder. Nevertheless, individuals with ADHD do typically exhibit deficiencies in working memory, and some studies on carnitine on memory improvement are of interest. There is evidence that memory improvement from carnitine treatment may be seen in certain sub-populations. For example, carnitine treatment improved visual memory and attention in Down Syndrome patients, but the same effects were not seen in non-Down Syndrome individuals. Additionally, carnitine has also been shown to be useful in Alzheimer's dementia. The possibility that unique subsections of the population may be particularly receptive is intriguing, to say the least.


5. Carnitine may play a role in reducing toxicity of other psychiatric medications: We have previously addressed the possible association of ADHD and epilepsy. Valproic acid, an anti-epileptic medication (which is also used in treating bipolar disorders, which often has a fair amount of overlap with ADHD itself) has risks of toxicity. However, carnitine treatment of Valproic acid toxicity has been shown in a recent study. In general, carnitine can also help the body clear toxic carboxylic acids from its cells.
   
   
6. Carnitine's lack of addiction potential compared to stimulant ADHD medications: One of the classic problems with many medications (including ADHD stimulant medications) is the potential for addiction. In general, addiction potential is increased by rapid uptake into and rapid clearance by the brain. Although much more rare than prescription medications, herbs and supplements may also be addiction forming. However, there is a relatively slow uptake of carnitine into the brain, which reduces its addiction potential to virtually zero. While not entirely significant (addictions of similar types of nutrients are almost non-existent), it is worth mentioning, if for no other reason than to inform those who are looking for non-prescription alternatives to ADHD some of the benefits to nutrient supplementation.
   
   
7. Acetyl-carnitine may offer the brain an alternative energy source during glucose shortages: Multiple studies have found glucose deficiencies in key specific brain regions in ADHD patients. A study found that glucose can actually inhibit the uptake of acetyl-carnitine into the brain, indicating a similar metabolic pathway. This conclusion of acetyl-carnitine as an alternative energy source was reached by the authors, however, it has been backed up by a body of research from numerous other studies. This seems to indicate that carnitine and its various forms may offer a viable means of alternative energy for glucose-starved ADHD brains.
   
   
8. Carnitine plays a role in acetylcholine (and possibly dopamine) synthesis: Acetylcholine is an important neuro-transmitter in the brain. While it often takes a back seat to more well-known ADHD-related neuro-signaling agents such as dopamine and norepinephrine, several stimulant drugs which alleviate ADHD symptoms may target acetylcholine-dependent pathways (interestingly, nicotine appears to have a high degree of interaction with the acetylcholine receptors, and is often a popular drug of choice in ADHD individuals, often as a means to "self-medicate").
   
   It appears that carnitine can help offset acetylcholine deficiencies in the brain, especially with regards to neuro-degenerative diseases. These effects can be even more pronounced if carnitine is co-administered with other key nutrients such as S-Adenosylmethionine (SAMe) and N-Acetylcysteine (NAc). To do these other two nutrients justice with regards to their effects on ADHD and related disorders or illness, they will need to be covered in their own separate posts. Finally, it appears that carnitine also affects dopamine-related pathways as well, which has numerous potential implications for ADHD, given that dopamine shortages and metabolic differences in key brain regions are often associated with the disorder.
   
   
9. Improved circulation via administration of carnitine (and vitamin E?): There is a mounting body of evidence that supports the assertion that individuals with ADHD have reduced bloodflow to key regions of the brain necessary for maintaining focus, eliminating distractions and maintaining attention to specific tasks. Certain ADHD medications, such as methylphenidate (Ritalin, Concerta, Metadate, Daytrana), can actually alter patterns of cerebral bloodflow in ADHD patients. It appears that carnitine can also improve blood flow to brain tissue (the study refers to the term "ischemia", which is simply a reduction of blood supply via blood vessels). These effects may possibly be increased even further, when combined with vitamin E, as highlighted in the same study. Carnitine can also help reduce ischemia to the spinal cord.
   
   
10. Carnitine helps maintain cell membrane integrity: Numerous diseases and disorders are the result of damages to (or "leaky") cell membranes. These membranes are comprised mainly of fats, with several different proteins interspersed among the fatty acids. Ample omega-3 fatty acids play a critical role in maintaining a structure to the cell membranes, which is one of the reasons why adequate carnitine levels are so beneficial. However, fatty acids are prone to oxidation (think of a damage similar to rusting or corrosion, but within the body), so adequate antioxidant levels are needed to maintain these key components of cell structure and overall health.
    
    In addition to its numerous other roles, carnitine is considered to be an antioxidant. Dietary deficiencies, as well as environmental stresses can leave these membranes prone to damage, resulting in a whole slew of potential diseases and disorders, such as increased risks of viral infections, allergies, buildup of cellular toxins, impairment of blood flow (this is actually related to our previous point on carnitine and ischemia) etc. In addition, cells contain inner membranes, whose structure and function can also be dependent on carnitine.

How much carnitine should we be taking, especially for ADHD?
This is a good question, which, unfortunately, does not carry a straight answer. There is no official "RDA" for carnitine at the moment. One group studying carnitine metabolism suggested a recommended daily dose of carnitine to be 200 mg/day. The Dutch study used a dose that was proportional to the patient's body weight, 100 mg of carnitine/kg body weight to be precise. This corresponded to a maximum of 4 grams of carnitine (note that this study was done in children) for the study. Dosage at this level corresponded to about a doubling in plasma carnitine concentration. With regards to side effects, there were relatively few, although one individual discontinued the study due to onset of a strange odor emanating from his skin. It was believed that this may be due to a buildup of a compound known as trimethylamine, which has a characteristic fishy, ammonia-like smell.

However, some of the effects in other studies were seen at only a fraction of these doses, such as some reporting effects such as significant improvements in attention at only 25 mg carnitine/kg body weight. 50 mg/kilogram body weight was the dosage used in a study that found carnitine to be effective in combating hyperactivity. These studies are simply rough estimates for amounts needed to suppress inattentive and hyperactive/impulsive behaviors associated with ADHD. As far as safety and toxicity issues are concerned, there are few published reports about dangerously high levels of carnitine. For a one-year study on the effects of carnitine for ADHD boys, a daily dose of 1 gram per day was found to be safe. This study recommended 20-50 mg carnitine per kg of body weight, which is roughly one fifth to one half of the levels used in the Dutch study.

Regional/Geographic effects on carnitine supplementation for ADHD: A mult-site study on the effects of carnitine on ADHD by Arnold and co-workers made an interesting observation. They studied the effects of carnitine on ADHD symptoms in children in 10 different sites across the United States, and found that significantly more pronounced effects were seen in 3 sites in Ohio and northern Kentucky. All of these sites were about 150 miles northwest of the Allegheny Mountains. The other parameters (age range, demographics, ethnicity, ADHD symptom scores, doses of carnitine, etc.) were similar to the other sites, and the researchers in the study offered no explanation for the findings and suggested the difference to be merely coincidental. While this is obviously a possibility, this blogger offers a possible explanation: the potential effects of interaction between carnitine and minerals or heavy metals.

One possibility may have to do with magnesium deficiency in this particular region. Some studies note that the soil in the Allegheny region is deficient in magnesium due to erosion or poor soil management. It is possible that this magnesium depletion in the soil may result in a higher prevalance to dietary magnesium deficiency in these geographic regions. We have demonstrated the effects of magnesium deficiency in ADHD in several previous posts, such as one on Magnesium Deficiency and Childhood ADHD. However, we have also seen that magnesium can often work in conjunction with other vitamins, minerals and antioxidants in treating ADHD as well. These highlights can be found in an earlier post on magnesium combination treatments and ADHD.

Some research has found that magnesium can boost the activity of the enzyme Acetyl-CoA carboxylase, which plays a significant role in fatty acid biosynethesis. A fatty derivative of carnitine can also push this same enzyme along. It is possible, therefore, that carnitine supplementation may take over some of the roles of the depleted magnesium, thereby freeing up magnesium for some of the other ADHD-fighting fuctions as previously noted. Of course this is just a personal hypothesis, but this blogger earnestly believes that there are a number of carnitine-mineral interactions that have not been studied extensively that warrant further investigation.

Carnitine does not act in isolation:
If you get nothing else out of this post or any of the other posts in this blog dealing with nutrition strategies for ADHD, please remember this: nutrient therapies often do not work because not all the pieces are in place. In other words, the different nutrients are highly interdependent, and a missing piece or two can sabotage the whole system. I personally believe that this is why a number of ADHD supplementation strategies do not work to their full potentials, because they are often missing key ingredients. Instead, for ADHD combination treatments to be effective, it is vital that we begin to understand all of the individual steps of nutrient metabolism and their affiliation with the disorder.

Just from this post alone, we have seen that carnitine has potential interactions with:

Omega-3 fatty acids
Vitamin E and other antioxidants
S-Adenosylmethionine (SAMe)
N-Acetylcysteine (NAc)
Magnesium
Glucose
Coenzyme Q10
Valproic acid (and other medications often used to ADHD or disorders which often show up alongside of it)

The point is, is that the various ADHD medications and treatment alternatives do not exist in a vacuum. One of the goals of this blog is to further elucidate the many interactions and factors at work in the different treatment strategies for ADHD. We need to consider all possible food-food, drug-drug, food-drug, food-supplement, drug-supplement and supplement-supplement interactions in order to tailor an effective treatment method for any individual. It is my belief that only then will we be truly able to see consistently effective individual treatments for ADHD and related disorders.

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Antibiotic Resistant Gonorrhea

Antimicrobial opposition in N. gonorrhoeae remains a vital challenge to put a control over gonorrhea; gonococcal strains may be opposing to penicillin, tetracycline, fluoroquinolones and spectinomycin. Resistance to CDC-recommended doses of ofloxacin and ciprofloxacin go beyond 40% in some Asian countries, according to World Health Organization (WHO)

Fluoroquinolone-resistant strains of N. gonorrhoeae have also been found in the Canada and the United States. The percentage of gonococcal isolates in Hawaii that are fluoroquinolone-resistant at present go beyond 13% and rising numbers of resistant strains have been acknowledged in the continent of United States.

Antimicrobial opposition in N. gonorrhoeae happens as plasmid-mediated resistance to tetracycline and penicillin, and chromosomally mediated opposition to penicillin, tetracycline, fluoroquinolones and spectinomycin,.

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Beauty Buzz: Chanel Cote D'Azur Collection Summer 2009

Tropical white sand beaches, hypnotic murmur of the sea waves, sea breeze air gently swaying the palm trees, white sleepy villas perched on cliff sides... Welcome to Cote D'Azur. With their new makeup collection Chanel takes you to a dreamland of azure waters, golden sunsets, and indigo sky.Cote D'Azur collection includes:Soleil Tan De CHANEL 4 Facettes Bronzing Powder - quartet of skin-warming

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When Things Aren’t Going Well

Yesterday I did a day-long training on the Restorative Approach. One of the participants asked this question:

What do you do when a certain kid just isn’t getting better, he does the restorative tasks without sincerity, he doesn’t seem to care how his actions affect others, and staff are losing their patience and becoming more punitive?

This is a very good question, and it has two parts:
What do we do to help the child?
and
What do we do to help the staff?

Regarding the child, this is the time to step back and reconsider our treatment. What has happened to this child? How do we understand his current functioning? What problem are his actions solving for him? What skills would he need to have in order to not need to do these things any more?

For example, Tyrell continuously attacks others, both staff and peers. He will apologize perfunctorily afterwards, but does not actually seem to care about having hurt someone. Tyrell was abused severely by his bio father, and then removed to live with his grand mother. Due to both health and mental health problems she was not able to care for him and he mostly fended for himself. He was removed by DCF at age 8 due to missing school and appearing neglected and uncared for, as well as not receiving medical care. Since then he has been in 7 foster homes and has had several short bits of treatment in hospitals. Most recently before this placement Tyrell was in a shelter.

So we know that Tyrell has no reason to trust adults, he has to take care of himself, he can’t afford to be small or weak or he will die, and the only weapon he has for survival is aggression. He undoubtedly blames himself for everything he has experienced. In order to decrease the aggression, Tyrell will have to feel safe. He will have to develop other ways of achieving mastery and control. He will need skills to manage his emotions, and need to begin to feel that he is worth something. And it would be good if he could gradually learn that some adults can be trusted and will actually help.

This will take a long time.

So let’s stop asking Tyrell to apologize to make amends. Instead, let’s think of what could actually help him feel stronger and more competent, and use the restorative tasks as opportunities to build skills. As it happens, Tyrell is an excellent artist and loves to draw comics. So, how about having him create a comic about a boy who fights others? Then we can show it to everyone, including the agency President, and make a lot of fuss about how good it is. Maybe he could draw a poster about anger. What does anger look like? Maybe he could create an "anger monster". Maybe gradually he could draw the boy in the comic conquering the anger monster. There is one staff, Robert, who is also an artist and likes comics and narrative fiction. Maybe he could be assigned to work with Tyrell on the comic project, and share some of his favorite comics with Tyrell, gradually building a relationship.

However, Tyrell’s behavior will take a long while to change, and it will be frustrating for staff when they are doing this excellent work and Tyrell is still hitting.

Which brings us to the second part of the question: How do we help the staff?

Often what these children need from us more than anything else is perseverance. We need stamina to stay with these children for the long, slow, uneven process of change. So how can we increase staff stamina?

Here are some ideas:

• Review the child’s history, understanding the meaning of his actions, and having a plan.
• Create a specific way of noting and sharing any progress anyone experiences with the child (we had a notebook "signs of hope with Stephen" regarding one child, and staff wrote down things like "Stephen said hello to me today.")
• Create plans to avoid having too much responsibility falling on one person- assigning different staff to alternate primary responsibility for this child each night, for example, or giving him two primary workers rather than the customary one.
• Talk about and acknowledge the frustration.
• Celebrate any good work a staff does with this child, no matter the out come.
• Have a sense of humor, make jokes about what is going on
• Do other things to have fun and connection with each other, such as pot luck lunches or sports teams.
• Remind ourselves that children who come back to visit have taught us that we never know when we are making an impact, and that children we thought were not at all involved remember everyone who worked with them and exactly what they said and did.

Do you have any other ideas about increasing staff stamina? Click comments and share them with us.

These kids have been wounded. They have learned to protect themselves in order to survive. We have to make plans that work in small steps and create tiny building blocks for the skills they need. And we need to take care of our selves and each other, because most of all the children someone to stick with them.

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Antibiotics for the treatment of Gonorrhea

Antibiotics that always used for the treatment of gonorrhea are:

1. Amoxicillin 2 g plus probenecid 1 g orally.
2. Azithromycin 2 g orally.
3. Ampicillin 2 to 3 g plus probenecid 1 g orally
4. Cefotaxime 500 mg by intramuscular injection
5. Cefixime or Suprax 400 mg orally
6. Cefpodoxime (Vantin) 400 mg orally
7. Cefoxitin 2 g by intramuscular injection, plus probenecid 1 g orally
8. Ceftriaxone (Rocephin) 125 to 250 mg by intramuscular injection
9. Ciprofloxacin 500 mg orally
10. Ofloxacin 400 mg orally
11. Spectinomycin 2 g by intramuscular injection
12. Levofloxacin 250 mg orally

These antibiotics are all given in a single dosage.

The intensity of tetracycline resistance in Neisseria Gonorrhœae (The bacteria which cause Gonorrhea) is now so high with regard to make it totally ineffective in most parts of the world. That’s why it is very difficult to eliminate Gonorrhea from the world.

The antibiotics fluoroquinolones (ciprofloxacin, levofloxacin or ofloxacin) cannot be used in pregnancy.

It is important to pass on all sexual partners to be checked for gonorrhea to avoid spread of the disease and to put a stop to the patient from becoming re-infected with gonorrhea. Patients are supposed to be offered screening for other kinds of sexually transmitted infections. In areas where joint-infection with Chlamydia is common, doctors may set down a combination of antibiotics, such dasoxycycline or azithromycin with ceftriaxone, to treat the diseases together.

Penicillin is unsuccessful at treating rectal gonorrhea: this is for the reason that other bacteria within the rectum or anal canal produce β-lactamases that demolish penicillin. All current treatments are not as much effective at treating gonorrhea of the throat, so the patient must be re-checked by throat mop 72 hours or more after being given cure, and then retreated if the result of throat swab is still positive.

Though gonorrhea generally does not need follow-up (with the exclusion of rectal or pharyngeal disease), patients are generally advised to phone for gonorrhea diagnosis results five to seven days after analysis to verify that the antibiotic they received was likely to be useful. Gonorrhea patients are advised to live without sex during this time of Gonorrhea infection.

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Beauty Review: Shiseido Hydro-Powder Eye Shadow

Recently I’ve been drawn like a magnet to eye shadows! Hardly a week passed after buying Guerlain’s spring palette, I found myself at Shiseido’s counter checking out their Hydro-Powder Eye-Shadow. As I’ve mentioned, I had a bad (sticky and creasy) experience with a creamy eyeshadow previously so I was a bit worried about giving a cream shadow another chance … Here is my review…Color: Spring

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A simple definition of Gonorrhea

Gonorrhea is a Sexually Transmitted Disease or STD. A sexually transmitted disease is an illness that has a considerable probability of spread or transmission between human beings or animals by means of sexual contact, including vaginal or anal intercourse, oral sex and alike.

Gonorrhea is a pus-discharging swelling of the urine passing canal known as the urethra, which passing through the complete length of the organ that carries both the seminal fluid and the urine. Gonorrhea is caused by a venereal bacillus, naming the gonococcus. Gonorrhea is a treatable sexually transmitted disease. Gonorrhea is most common in young adults.

Under positive conditions and with precise treatment, gonorrhea may be healed, although may be sadistically painful, in a single dose to 14 days. Often the swelling extends, becomes persistent and attacks other organs of human body. This chronic gonorrhea often causes infertility in both men and women.

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About Gonorrhea Treatment

Positive test result for a sexually transmitted disease is not amusing. The reports can hit you hard and everybody reacts in a different way. The worse the sexually transmitted disease the worst emotion you must have. There is nothing pleasant regarding getting a positive test result for sexually transmitted disease. If you are looking to keep away from this kind of thing, perhaps you should think treatment straight away.

In regards to treatment of gonorrhea, there is good news. The disease is simple to treat and is not going to be some extreme experiment in regards to serving you. The most vital thing you can do is to ensure that you see a doctor immediately when symptoms appear and get yourself some medicine fast. This is going to be your friend in regards to treating and getting cured of this disease that is ultimately preventable.

Gonorrhea Treatment is not wild. It is simple to get right to use medicine, just merely go to a doctor and obtain this taken care of. You are heading for obtaining an antibiotic medicine to help this. It can either be an injection or a pill and most of the times only one dose is going to cure you. Though, some antibiotic treatments do last more than a few days and are not too extreme to apply. Some medicines are not simply given to pregnant women, so you ought to be cautious and ensure you tell your doctor.

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Chances of getting HIV when you already have Gonorrhea

There are more chances of getting HIV when you already have Gonorrhea?
In case a person infected with gonorrhea had to have sex with someone who had HIV, he have 60% more chances to get HIV or AIDS.

The reason is that if you have a present a sexually transmitted infection going on in your body for instance, herpes, Chlamydia or gonorrhea then it is easier for HIV to infect you for the reason that your body is already past hit from the other infections.

Though, you have still had to get exposed to HIV from an infected person. The majority people don't know the fact that the transmission rate for HIV is in fact low in healthy human beings. So there are more chances that you have sex with an infected person and not get the HIV virus. You might have to have sex and intercourse with that person more than a few times.

Though, if you already got an infection like gonorrhea and it is continuously going on, then it’s easier to get HIV. So like having sex with that HIV infected person only one or two times, you may get HIV.

So always keep away from sex until you have a proper treatment and cure of Gonorrhea.

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Beauty Buzz: New Makeup This Spring

What’s new in makeup this spring?Freeze launched a mineral makeup collection with anti-aging ingredients. They call it “Advanced Age-less Mineral Makeup”. The makeup has SPF 18 and promises to pamper, hydrate and protect your skin.Here is what Freeze24-7 & Glow Basics Kit Includes: • 2 Age-less Mineral Foundations SPF 18 • 1 Bronze-to-Glow • 1 Cheeky Highlighter • Total Face Brush • Fix-It Brush

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10 Ways Zinc can Combat ADHD

Here are 10 reasons why zinc may be an effective treatment method for ADHD and related disorders:

1. Protection against oxidative damage of omega-3 fatty acids: We've previously discussed the role of omega-3's and their use as a treatment option for ADHD. However, the downside to this is that these fats (along with many others) are prone to oxidation. As a result, dietary antioxidants are needed to preserve these effects. According to a work by Villet and coworkers, zinc may be beneficial in retarding this omega-3 fatty acid oxidation process. As a result, zinc may be a good supplement to go alongside omega-3 treatment for ADHD.
   
   
2. Conversion of Vitamin B6 to its active form: We have mentioned the role of vitamin B6 and its role in the treatment of ADHD, including how B6 can work alongside another key nutrient, magnesium. Zinc is needed to convert the inactive form of the vitamin B6, pyridoxine, to the active form pyridoxal phosphate. Thus, zinc is needed in vitamin B6 metabolism.
   
   
3. Production of melatonin: Melatonin is a hormone we have also discussed earlier with regards to its effects on ADHD in an earlier post titled CREM gene, melatonin and ADHD. It appears that melatonin deficiencies may be attributed to a shortage of zinc. In short, melatonin plays a role in regulating the important neuro-chemical signaling agent dopamine, which is a key neurotransmitter involved in the symptoms and treatment strategies for ADHD.
   
   
4. Zinc can modulate or affect thyroid function, especially when melatonin is a factor: We have also discussed how thyroid dysfunction may closely mimic ADHD symptoms, and highlighted the importance of iodine to combat this . Now it appears that imbalanced melatonin levels may disrupt the thyroid. However, zinc may combat the negative effects of excessive melatonin on thyroid function. Combining this point with the previous one, we now see that zinc may be needed not only for the production of melatonin, but can actually be used to reel in this hormone when excessive melatonin levels lead to unwanted side effects such as thyroid dysfunction. Thus, it appears that zinc may play a role of double duty with regards to regulating melatonin production and curbing the negative effects of its excess.
   
   
5. Production of serotonin: This piggy-backs on the vitamin B6 role highlighted in point number 2 above. ADHD is often considered a disorder associated with the neurochemicals dopamine and norepinephrine. However, serotonin may also play a role in this disorder. For individuals who exhibit anxiety and depressive symptoms alongside their ADHD (which is surprisingly common), a serotonin deficiency is often partly to blame. Serotonin is synthesized in the body from the amino acid tryptophan. However, for this conversion process to go through, sufficient and functional vitamin B6 is required for serotonin to be formed by the tryptophan conversion process via a special type of enzyme known as aromatic amino acid decarboxylase. As previously mentioned, zinc is needed for functional vitamin B6, and therefore plays an indirect role in the synthesis of serotonin. Thus, zinc may be extremely important in individuals with ADHD and comorbid (co-occurring) depression or depressive-like symptoms.
   
   
6. Reduction of hyperactivty, impulsivity and antisocial behavioral symptoms: For direct treatment of ADHD, it appears that zinc may be more effective in treating the hyperactive/impulsive aspects of the disorder than the inattentive portion of the disorder. This study also noted the effectiveness of zinc for older children and children with a higher body mass index, which at least suggests that the effectiveness of zinc as a treatment for children with ADHD may increase as the child ages and grows.
   
   
7. Zinc may also play a role in the process of brain waves associated with ADHD as well as other disorders: We have already investigated differences and discrepancies in the brain wave patterns of ADHD children, including how these may actually be tied to an individual's genes. Information processing, which is often impaired in ADHD individuals, is believed to be tied to a brain pattern known as N2 (which is short for second negative wave, no need to concern ourselves with the exact details of this process here). Some research suggests that N2 mediated information processing may be negatively affected by zinc deficiency. This relates to unwanted attentional shifting (i.e. distraction) to irrelevant stimuli. In other words, N2 is related to the "novelty effect" of a specific stimulus or change in stimuli. As an interesting aside, N2 brain patterns are thought to be affected by serotonin, which, as mentioned in point #5, is indirectly tied to zinc levels. Based on this, it is at least plausible that zinc may play an integral role in this mechanism of distraction.
   
   
8. Boosting the effectiveness of ADHD medications: While we have reported on this in an earlier post on zinc and Ritalin, I believe it is worth repeating here. Multiple studies suggest that zinc can boost the effectiveness of methylphenidate for treating ADHD and related disorders. This may be of importance with regards to reducing some of the negative side effects associated with the drug. Many of these negative side effects often don't set in at the lower doses of the various forms of the drug, but instead, begin to appear with greater frequencies at higher doses. Taking this into account, it seems reasonable (at least in this blogger's opinion) that concurrent treatment with zinc may be enough to hold some of these methylphenidate dosages below the threshold of some of these negative symptoms, thereby increasing the tolerability of this common ADHD drug.
   
   
9. Zinc Inhibition of the Dopamine Transporter Protein: This may offer a further explanation as to why zinc is effective in boosting the effectiveness of methylphenidate. We have spoken extensively about the dopamine transporter (DAT) protein and its effects on dopamine levels and ADHD. Several ADHD medications, especially of the stimulant variety (such as methylphenidate), work by inhibiting or blocking DAT. It appears zinc may also act as a natural DAT inhibitor, thereby mimicking the effects of some of the more commonly used drugs.
   
   In my previous post on zinc and its amplification of Ritalin's effectiveness, I wondered aloud as to whether zinc could be used as an outright substitute for the medication methylphenidate. While still a personal hypothesis, I still believe that for low level doses, zinc may be an ample natural alternative, but, this hypothesis obviously needs to be tested at a clinical level. Nevertheless, I personally believe it to be worthy of investigation.
   
   
10. Zinc as a possible treatment option for juvenile growth impairments: It is suggested that children with ADHD exhibit a delay in the overall growth process. We actually discussed this very topic in an earlier post titled: Do ADHD stimulant drugs stunt growth? Now it appears that zinc may possibly play a role in this. Using a primate model of zinc deficiency, Golub and coworkers found that zinc deficient monkeys showed a slowing of the growth process during what would normally be a period of growth spurt. If this translates into humans, then it is possible that underlying growth and attentional impairments, as well as abnormalities in activity levels (which is sometimes evident in children with ADHD, often more alongside those with the inattentive subtype of the disorder), may actually be due to zinc deficiencies.
    
    Perhaps on an even more interesting note, the study found that "attention performance was also impaired before the onset of growth retardation". In other words, an attentional deficit may serve as a proverbial canary in the coal mine that a child may suffer from a subsequent delinquency in growth in the upcoming years. As a result, this blogger personally believes that some of these "attentional deficits" may not simply indicate an isolated case of ADHD, but rather serve as a warning of a much larger underlying problem that may be tied to a nutritional deficiency. Furthermore, it is at least possible that the underlying problem of attentional deficits and growth impairments in children with ADHD may be remedied by an intervention strategy that involves adequate dietary zinc or treatment via zinc supplementation.
    

This list of zinc levels and the direct or indirect relationships to ADHD is by no means extensive. Further connections, such as the relationship between zinc deficiencies and digestive disorders such as Crohn's disease, should also be noted. On an interesting note, a very recent publication came out evaluating the effectiveness of various nutrition supplementation strategies for treatment of ADHD listed zinc as the nutrient of most promise.

Given that zinc deficiencies are common in both Western countries such as the U.K., as well as developing countries such as China it seems evident that ADHD symptoms may be part of a larger picture, a proverbial cry for help due to a widespread nutritional deficiency. In addition to ADHD, other disorders dealing with cognitive development may be susceptible to zinc deficiencies. Of course, a great deal of further study is needed to back up this assertion, but it leads us to wonder exactly how often a case of ADHD is actually due to something as simple as a deficiency in zinc or another common nutrient. We will have further discussions regarding this important mineral in future posts.

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Beauty News: New Ingestible Ingredient Brings Relief to Sensitive Skin

With the launch of a new ingestible ingredient developed by P.L.Thomas, people suffering from skin irritation, itchy, flaky skin may expect release of a new supplement to resolve these skin problems from within.The ingredient is a protein filtrate from sweet whey and will be available in an oral form to relieve mild-to-moderate skin irritations. This ingredient was tested in clinical trials on

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The Restorative Approach and Boundaries

People some times assume that because the Restorative Approach emphasizes relationships and speaking from the heart, we are throwing out the idea of boundaries. Quite the opposite is true! For relationships to be safe and healing, the boundaries must be clear, reliable and trustworthy. This is even true of personal relationships, and it is all the more true of professional relationships.

Because abuse is in its essence a violation of boundaries, it is especially important that we pay attention to boundaries when working with abused clients. Our children have experienced major boundary violations, such as sexual abuse. They have also experienced many other chronic, less obvious boundary problems. Many of our children have had to handle responsibilities far beyond was is reasonable for their age, such as an eight year old being responsible for her two year old sister. They have been way too involved in adult issues, such as being worried about the rent or finding food. They have been exposed to adult sexuality and to relationship worries. They have had to parent their parents- care for a sick mother, listen to parental problems, help ease a parent’s depression.

Often times within these inappropriate adult responsibilities our children have found great satisfaction. Janeese is proud that she of kept her two year old sister safe. Louis feels good about having been the man of the house while his mother was sick. Darlene felt special when her mother confided her problems with her latest boyfriend.

Also, being aware of adult issues and taking on adult responsibility is a survival strategy. The adults that these children have known were not capable of protecting them. If the kids didn’t do it, no one would. So when Jackie asks her therapist fourteen times if she has called her DCF worker to approve a visit yet, and also places a call to the worker herself, it is because she has no experience that adults will do what they promise to do, and she has much more experience that if she wants something done she has to do it herself.

So we come along and say- it’s okay, we will take care of everything, you can relax and be a kid now- our children’s answer is "yeah, right." They don’t believe us- and they don’t want to give up the sense of competence and strength that they have developed.

Our children pull for boundary violations. They are eager to become staff’s best friend. They try to engage with staff sexually. They continually test, asking with their behavior: who are you to me? Can I trust you? Are you really who you say you are?

It is up to us, as adults, to maintain the boundaries. We are professionals, and our relationships with the children must be primarily to meet their needs, not to meet ours.

We ask staff to speak from the heart. Yet there is a big difference between saying:
"You ran away last night and I was worried about you. I was wondering if you were safe."
And saying:
"You ran away last night and I was worried about you, and I haven’t been sleeping anyway because of my financial problems and the fact that my grandmother is sick and I can’t believe you added to my stress."

Some boundaries are clear cut:
Do not have sex with the kids. Or with their families.

But within our field there are a lot of gray areas, and a lot of disagreement between treaters. Many boundary issues arise out of good intentions- someone wants to do something extra for a child, someone feels compassion for a family.

Here are some examples of the many issues that can arise:

Margaret is a teacher and one of her students, Rachel, is having an especially hard time as her mother has disappeared and no one knows where she is. Margaret plans to come in and take Rachel to lunch this Saturday to help her through this.

Danny’s mother felt that his team mate, Seth, was particularly kind and sensitive to her during a recent episode when Danny ran away and was missing over night. She brings Seth a $30 gift certificate to a local restaurant as a thank you.

Doug recently bought his son some new expensive sneakers, and his son wore them once and didn’t like them. It is too late to return them, but he knows that Jarell is just the same shoe size as his son so he brings the sneakers in for Jarell.

Sarah is a therapist and is seeing Anita’s family. They can’t concentrate on their issues with Anita because they tell her they do not have any food in the house and do not know where to get any for that night. Sarah wonders if she should just give them $20.

Many other dilemmas arise. The issue of staff/child touch is a particularly sensitive one, and different agencies have different policies around this. Another area fraught with complications is when a staff or a child leaves the agency.

Amidst this morass of complexity, how is a staff member to know what to do? The answer is simple: talk about it. First, know and consult your agency’s boundary policy. Yet no policy can cover all the decisions we are faced with. So if you are considering doing anything out side your job description, before you say anything to the child or family, discuss it with your supervisor and/or your team. What would be the effect of this action on the child? On the group? On other staff? Are you making any implicit unrealistic promises about your role to the child? How will you feel if you do this extra thing and then the next day the child is mean to you? There are many sides that must be considered. Supervisors and team members must be alert to boundary issues on their team, and challenge decisions that seem problematic, even at the risk of seeming like the Scrooge of the team.

No matter what treatment system we are using, boundaries are crucial in creating healing relationships. Supervision and team discussions are our most powerful tools to sort through the complexity and do what is right for the children. The children cannot grow and change unless they feel completely safe in the strong, clear relationships we offer them.

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