Already ten minutes late for her first appointment, Claire phoned from her car that she’d be in the office in five minutes. Fifteen minutes later, she arrived flustered and embarrassed, and “Oh, my gosh, I left all the forms on my kitchen table, but I did fill them out,” and “My insurance card? I’m sure I had it, I can call my husband, he has one, I think,” and “Could you please put money in the meter for me, I just realized I forgot and I have s-o-o-o many tickets…”
Claire wanted to see me about fatigue, but she also wanted to mention her concern about a possible yeast infection, and then there were her hormones, and could she see the nutritionist too on this visit? She jiggled her knee constantly as she spoke, answered my questions mid-sentence, and changed the subject frequently.
I asked her — slowly, carefully — if she’d ever been diagnosed with attention deficit disorder (ADD). “Funny that you should mention ADD,” she replied.
“My best friend, Sarah, she makes jewelry, sells it at art fairs, she’s got a website with pictures. What did you ask me again?” Sarah, I learned, thought Claire had ADD, but no, Claire had never been tested for it, and yes, she’d finished college, “so my ADD can’t be that bad, though it did take me eight years to get my degree.”
I asked if she’d take an ADD test with me. We took this one. “Well,” she laughed, “That’s the first time I’ve ever gotten a 100 on any test.”
Doctors can diagnose ADD with a combination of observing the patient and asking some pertinent questions. When the situation calls for it, I refer patients to WholeHealth Chicago’s Dr. Janet Chandler, a psychologist who can do more extensive testing.
What doctors are learning is that there are far more adults, especially women, with ADD than anyone ever suspected. Until relatively recently, physicians were taught that ADD was pretty much confined to boys, and fairly easy to identify because of hyperactivity, inattentiveness, and easy distractibility. I remember being taught that the condition was rare in girls.
In addition, for many years doctors believed that children with ADD simply “outgrew” it – that medication could be discontinued during adolescence. This too turned out to be wrong. Children do become less hyperactive over time, but the inattention and distractibility continue unabated. As adults, they struggle because their medication was (inappropriately) discontinued. Untreated men with ADD have a real problem controlling impulsive behavior. It’s estimated that half the men in jail have some degree of ADD.
Today we know that young girls can have the same ADD symptoms as boys … except for the hyperactivity. The girls are sitting quietly in class but their brains are like TV sets with a dozen channels going at once. Until relatively recently, girls with ADD went undiagnosed, but they eventually grew up and we now have an immense population of undiagnosed and untreated adult women with ADD. How many? Experts believe 7 to 10% of the population (both sexes) probably has ADD.
The result of this oversight: millions of women 25 and older have been struggling through their lives impaired by their undiagnosed ADD, and they’ve experienced incredible challenges with learning. People with ADD endlessly hear, “You’re not living up to your potential.” They may fail to advance in their jobs (and may make frequent job changes), experience difficulties with relationships (“I always interrupted him”), and even with sex (“he could tell my mind was somewhere else”).
Most people with ADD compensate by living in a veritable snowstorm of Post-It notes, memo books, and Blackberries. Generally, their workspaces are chaotic (piles instead of files), and they go through life missing deadlines and appointments, procrastinating, and losing things.
Some women are finally diagnosed when one of their children is found to have ADD. Others struggle through life not knowing why.
The sad irony is that when treated, women with ADD are quite often fiercely intelligent, frequently surprised by how easy learning actually is and how powerful memory can be. Many feel sad when they realize how different their lives might have been had someone recognized their ADD when they were, say, seven years old.
We introduced Claire, one of the millions of women with ADD (attention deficit disorder), who readily acknowledged the condition explained her struggles with school, job, relationships, and the general chaos of her apartment. And why she was a half hour late for her appointment.
“I lose my keys endlessly. I pay big bucks in needless fees on bills that I put down somewhere and just forget about. After I finished college, I never read another book — it was just too much work. I can deal with a magazine article but hardly ever remember what I’ve read. I even have trouble following conversations. There’s just too much chatter in my head.”
“All ADD symptoms,” I said.
“But I don’t want to take drugs. I don’t want the chemicals in my body.”
I hear that a lot at WholeHealth Chicago, and it can be a challenge, especially because ADD meds can work really well. But I’m certainly willing to give the natural route a try, and if it works, terrific.
Natural ADD Treatment
At the heart of the matter, ADD patients have difficulty producing or correctly processing one or two neurotransmitters — brain chemicals that allow cells to communicate with each other. We’re familiar with a third neurotransmitter, our stress-buffering serotonin, and although a serotonin shortage can occur with ADD (for example, in people who have ADD + depression or ADD + anxiety), I treat it separately.
The “ADD neurotransmitters” are dopamine and norepinephrine. When levels are low, patients have difficulty with focus and concentration, inattentiveness and easy distractibility. As you might guess, ADD meds boost either the dopamine or norepinephrine. I prescribe drugs to raise one or the other but never both, as the meds are quite potent.
Focusing on nutritional supplements, as we were for Claire, I endeavor to raise levels of both.
If you elevate these neurotransmitters in someone who doesn’t have ADD, the sensation is similar to drinking too much Starbucks. In fact, if you need your morning caffeine to focus, you’re self-treating a very mild ADD. Paradoxically, boosting neurotransmitters in an ADD patient actually is calming and focusing, not stimulating.
So here’s what I recommend for people with mild-to-moderate ADD who want to take a natural route first:
- Try a food sensitivity elimination diet: Sometimes (though not often), there’s a food culprit. If you feel calmer after a couple of weeks, reintroduce one food group every few days to locate the offender. Also, avoid artificial colors and preservatives and reduce sugar and simple carbs, like white flour.
- Concentration exercises: Concentration can be a major challenge for ADD patients, but I’ve seen a few people reduce or even eliminate their meds using meditation and exercises like these.
Supplements: Nutritional supplements are geared toward normalizing neurotransmitter shortages:
• D, L-Phenylalanine, 500 mg twice daily (taken early in the day to prevent overstimulation), is an amino acid needed for the brain to make more dopamine.
• L Tyrosine (same dose and recommendation) makes more norepinephrine.
• B complex, one daily (B vitamins are needed for neurotransmitter production).
• Fish oil, twice a day (also used in neurotransmitter production).
To anticipate your question, if you don’t have actual ADD but wish to improve your focus and concentration, will these supplements help? The answer is yes, but reduce the doses of the first two if you feel overly stimulated.
How Claire fared going the natural route — and what she ultimately chose to do — is the subject of next week’s health tip.
David Edelberg, MD