An Apple A Day

The rate of Attention Deficit Hyperactivity Disorder (ADHD) is rapidly rising and estimated to be 12% nationwide by US Census Bureau data. According to community estimates, ADHD rates are as high as 20% in some areas. Nationwide the percentage of children receiving prescription medication for ADHD is approaching 5% (and well over that in some areas). As the number of children diagnosed with ADHD soars in the US, parents, educators, health care providers and scientists are asking, “why”?

The list of answers and possible explanations is quite long. With no blood test to diagnose ADHD, and many reasons why overworked teachers, stressed parents and hurried doctors would want easy fixes, stamping a child with the ADHD label and starting that child on medication is an appealingly quick shovel-it-under-the-carpet response. Anyone with the most superficial experience of the challenges posed by these children will be sympathetic.

One reasons for over-diagnosis is uncertainty about what really is normal. Kids who are creative and unusually smart, need challenges or they will often create them for those around them. Kids who learn well but need a lot of physical activity also draw negative attention. Sadly, a child who sits quietly underachieving is often neglected. We live in a culture where driving a two ton metal projectile hurtling down the road, inches away from dozens or even hundreds of other vehicles, is boring. So we crank it up by talking on the phone, messing with CDs, running videos in the car and TEXTING! Driving has become our most popular extreme sport. Our culture is ADHD. We create children in our own image.

Cultural elements have a huge impact. So does diet. As I’ve discussed before, many in the medical community have decades-long experience of the ADHD-reducing effects of a diet limited in additives, preservatives and sugar. Even the British government is on board with this idea, after they funded a study expecting to discredit the theory. Prenatal care is vital, as is getting enough of the right nutrients, physical activity, positive parenting and teaching. Besides avoiding food additives, more and more research is linking unwanted “environmental additives” (ie, toxins) to ADHD.

The latest is a newly released Harvard study of nearly 250 pregnant women. Researchers tested their urine for BPA, finding it in over 97% of the women, and compared those BPA levels to mothers’ reports of ADHD behaviors in their children at age 3. With each 10 fold rise in BPA levels, there was a significant rise in mothers’ reports of their daughters’ emotional instability, anxiety and depression. Although ADHD is much more common in boys, there was no correlation between BPA levels and the behaviors of boys in this sample.

For decades now, we have known that the poisons we dump into our world poison our brains, causing ADHD and other problems. In the early 1970’s Harvard researcher Herbert Needleman discovered a very close correlation between blood lead levels and IQ. Since then the list of bad actors grows year by year. Organophosphates, developed for chemical warfare and present now in herbicides, pesticides and other chemicals, cause severe neurologic damage, as originally intended. Studies by UC Berkeley on the young children of agricultural workers in California’s Central Valley, by Harvard on preteen and early teens and by Columbia have all found links between even barely detectable levels of organophosphates and ADHD. In 2008, 20-30% of US samples of foods such as celery, strawberries and blueberries found contamination with one or more organophosphates. Korean studies have discovered strong links between phthalates and ADHD in school-aged children. Government research shows that nearly every American man, woman and child now has detectable levels of phthalates in our bodies.

What to do? Follow the essential health habits. Drink enough water. Exercise. Eat a healthy diet. Take a moderate amount of vitamin and mineral supplementation. Develop and maintain a positive attitude and social interactions. Avoid the stuff that makes us sick. That covers a broad range. Avoid food additives, including preservatives and flavoring agents. Select foods least likely to expose you to unwanted chemicals (review the list below and favor organic and local). Make your water as clean as possible. Create a stable, calm and pleasant environment. Use music and physical activity to help your child move in the rhythm that suits him or her.

Most contaminated

Fruits - peaches, apples, nectarines, strawberries, cherries, imported grapes, pears

Vegetables - bell peppers, celery, kale, lettuce, carrots

Least contaminated

Fruit - pineapples, mangoes, kiwis, papayas, watermelons

Vegetables - onions, avocados, sweet corn, asparagus, sweet peas, cabbages, eggplants, broccoli, tomatoes, sweet potatoes

Over time we have gotten used to the idea that some things we cannot see, can still cause us harm. In fact, much longer ago, say 1,500 years, people were concerned about vaporous humors floating out of swamps and causing illnesses. Those ethereal malefic influences often proved to be tiny creatures like mosquitoes carrying invisible ones like bacteria. Since Rachel Carson proved that DDT was ruining our world despite its invisibility, we have learned to be skeptical about all kinds of things.

Most of us, including me, would rather not have to worry about something else, especially another invisible but ever present hazard. A new study dealing with electromagnetic radiation provides an unpleasant jolt to our complacency. Given the strength of the study and the potential impact of the finding, I am more than a little surprised by the lack of media attention. Maybe that is because no one really wants to believe it, especially electronic media workers and their bosses?

Whatever else anyone has to say, good or bad, about Kaiser, clinical records of Kaiser patients are a goldimine for researchers. Dr. De-Kun Li is a researcher working for Kaiser, specializing in reproductive and hormonal health studies. Years ago, this group found that exposure to electromagnetic fields (EMF) doubled the risk of miscarriage for pregnant women. This time they studied pregnant Northern California patients, looking for an association between EMF exposure and asthma. The study design was particularly strong for this kind of research. They gave over 800 pregnant women monitors to wear, measuring EMF exposure during pregnancy. The children were tracked until age 13 to learn which of them developed asthma.

Children of women with the highest levels of EMF exposure during pregnancy were three times more likely to develop asthma than children of the least EMF exposed mothers. The greatest EMF exposure came from home appliances (hair dryers, microwave ovens and vacuum cleaners). The meters used did not measure radio frequency energy, so this study teaches us nothing about smart meters, cellphones and the wireless networks all around us. Dr. Li, however, has also expressed his concern about radio-frequency exposure.

Forgive me for rattling on about vitamin D, but it is VERY important. The latest news is even more important than usual, and it is notable for at least three reasons, maybe four, if we count the fact that Mother’s Day is fast approaching.

The most meaningful studies are designed as interventional trials, where people are divided into groups, each receiving different treatments, and then their responses analyzed statistically to determine if the treatment had any effect. This study was designed in that way, with women who were pregnant for 12 weeks or more randomly assigned to receive either 400, 2,000 or 4,000 iu of vitamin D a day. Researchers then tracked their risk of major complications of pregnancy, including premature labor, premature birth and infections. The highest dose of vitamin D, 4,000 iu/day, was clearly associated with the lowest rate of complications.

First, this is important because pregnancy complications are serious and common.

Secondly, because showing that doing something has an effect demonstrates cause not just association.

FInally, given official warnings that taking 2,000 iu/day of vitamin D is the safe upper limit, I am impressed that they were able to get the study approved. Human Subjects Committees at research institutions are mandated to block research that endangers the subjects of the trial. For example, 15 years ago, when I conducted the first national survey of alternative medical instruction in US medical schools and family practice residency programs, the Human Subjects Committee at UCSF refused to allow me to resend questionnaires to schools that did not respond to the first one, as they felt that I would be harming them by such a request. Seriously. Thankfully, the particular HSC involved in this case was courageous enough to approve this vitamin D study. As such research is needed and human subjects committee can be ridiculously conservative, this is not a minor event. I find that most patients need well more than the “safe limit” of 2,000 to bring their blood levels up to normal. This “safe limit” is completely wrong and unscientific. It must be changed, and the sooner the better.