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ADHD Treatment from an Integrative and Functional Medicine Perspective


Trees depicting ADHD and neurodivergence and possible integrative psychiatry and functional medicine treatments.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neuropsychiatric condition, presenting challenges in various aspects of life due to symptoms like inattention, hyperactivity, and impulsivity. While stimulant medications are often the first line of treatment, not everyone finds them effective or tolerable. In such instances, an integrative approach, combining conventional and functional medicine techniques, can offer valuable alternatives or complementary strategies.



Understanding ADHD and Conventional Treatments

ADHD affects both children and adults, leading to difficulties in academic, occupational, and social settings. Common medications include methylphenidate and amphetamines, which, despite their effectiveness for many, can cause side effects or inadequate responses in some individuals. This variability in response underscores the importance of a comprehensive approach to treatment.


The field of pharmacogenetics examines how individual genetic variations affect medication response. This is especially relevant in understanding medication tolerability and side effects. For example, variations in the CYP2D6 gene can influence how the body metabolizes amphetamines, and the CES1 gene affects the metabolism of methylphenidate (MPH). Understanding one's genetic makeup through pharmacogenetic testing (Genomind or Genesight are the most commonly utilized tests) can help guide treatment decisions and minimize adverse reactions.


The Crucial Step: Ruling Out Other Causes

Before initiating any ADHD treatment plan, it's imperative to exclude other potential causes of the symptoms. Conditions such as trauma, traumatic brain injury (TBI), mold toxicity, tickborne diseases, gut issues, and food sensitivities can mimic ADHD symptoms, leading to misdiagnosis and possibly inappropriate treatment that doesn't address root causes.


  • Trauma and TBI: These can impact attention, focus, and emotional regulation, often confused with ADHD (Chan et al., 2023; Ilieva et al., 2020). Differentiating them may require a thorough history and neuropsychological testing (Halstead et al., 2015).

  • Mold Toxicity: Cognitive difficulties, fatigue, and mood swings caused by mold exposure can mimic ADHD (Afshari et al., 2019; Dearborn et al., 2008). Testing and addressing mold exposure is crucial (CDC, 2023).

  • Tickborne Diseases: Lyme disease and other tick-borne illnesses can present with inattention, hyperactivity, and sleep disturbances (Bennet & Dwelly, 2017; Mead et al., 2020). Proper testing for underlying infections is essential (CDC, 2020).

  • Gut Issues and Food Sensitivities: Gut health imbalances and food sensitivities can affect mood, behavior, and cognitive function (Biederman & Monuteaux, 2017; Pennell et al., 2022). Dietary interventions and optimizing gut health may be necessary (El-Rashidy et al., 2020).

  • Other Medical Conditions: Thyroid disorders, sleep apnea, and anxiety disorders can share symptoms with ADHD (Meltzer-Brody et al., 2016). Ruling these out is important for accurate diagnosis and treatment (NIMH, 2023).

The Role of Functional Medicine in ADHD Treatment

Functional medicine focuses on identifying and addressing the root cause of diseases. This approach emphasizes the importance of evaluating each patient's lifestyle, environment, and genetic factors, potentially uncovering issues like nutritional deficiencies, gut health imbalances, infections, or environmental toxins contributing to ADHD symptoms.


Integrative Strategies for Managing ADHD

Integrative psychiatry combines conventional treatments with complementary therapies. Key strategies include:


  • Dietary Modifications: Reducing sugar intake and eliminating potential allergens can manage symptoms (Millichap & Yee, 2012). Individuals may find benefit in working with a healthcare professional to complete an elimination diet but this may not be recommended for everyone.

  • Nutritional Supplements: Omega-3 fatty acids, zinc, and magnesium have shown potential benefits (Bloch & Qawasmi, 2011; Arnold et al., 2011). While preliminary research suggests potential benefits of saffron (Modabbir et al., 2018), pycnogenol (Mori et al., 2015), L-theanine (Ritschel et al., 2015), and bacopa (Pase et al., 2012) for ADHD symptoms, consult a healthcare professional before considering herbal options. They can help weigh potential benefits and risks, considering individual needs and potential interactions with existing medications.

  • Mind-Body Practices: Yoga, meditation, and mindfulness can improve symptoms, especially alongside traditional treatments (Haffner et al., 2016). Meditation can be particularly challenging for individuals with ADHD but it is important to remember that there are many different forms of mind-body practices and even small steps towards incorporating this into one's daily routine can have significant benefit.

  • Behavioral Therapies: Cognitive Behavioral Therapy (CBT) and other interventions such as executive functioning coaching to develop coping strategies and organizational skills.

  • Exercise: Regular physical activity improves concentration, motivation, memory, and mood. While there is no single type of exercise universally prescribed for ADHD, various forms of physical activity have shown promise in improving symptoms, such as aerobic exercise, yoga, team sports, martial arts, outdoor activities, and HIIT (Hoza et al., 2015; Haffner et al., 2016). Overall, the best type of exercise for ADHD (as well as for everyone) is one that the individual finds enjoyable and can engage in consistently.

Embracing Self-Acceptance and Thriving Environments

Living with ADHD can sometimes feel challenging, but it's important to give yourself grace and recognize that there's nothing inherently wrong with you. Embracing your unique strengths and understanding how you work best can be empowering. Rather than forcing yourself to fit into work environments or situations where you don't thrive, seek out spaces that align with your abilities and work style. This approach is not about limiting yourself, but about really honoring your strengths in environments that are conducive to your success.


The book "ADHD 2.0" offers insightful perspectives on this topic, providing practical advice and strategies to help individuals with ADHD understand and harness their unique strengths. It's a recommended read for anyone looking to gain a deeper understanding of ADHD and how to thrive with it. The more that you can educate yourself and become informed, the more empowered you will be. Fortunately, there are lots of books and podcasts out there now about neurodivergence (which includes ADHD) that are informative and often very validating.


Conclusion

While stimulants are effective for many with ADHD, an integrative approach incorporating functional medicine principles provides additional options. This holistic strategy emphasizes the importance of a tailored approach, considering the unique needs and circumstances of each individual. By exploring various integrative and functional medicine strategies and ruling out other potential causes, individuals with ADHD can improve their symptoms and overall well-being.


Interested in working together? Dr. Burger is currently accepting new patients interested in a whole person, integrative psychiatry and functional medicine approach to helping individuals struggling with ADHD. Learn more here.


A kind reminder: This blog post is designed as a general guide. This is not a substitute for personalized medical advice, nor is a patient-physician relationship established in this blog post.



References

Arnold, L. E., Bozzolo, H., Hollway, J., et al. (2011). Serum zinc correlates with parent- and teacher-rated inattention in children with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 21(4), 297-302.


Haffner, J., Roos, J., Goldstein, N., Parzer, P., & Resch, F. (2016). The effectiveness of mindfulness-based interventions on attention-deficit/hyperactivity disorder: A systematic review. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 44(5), 318-328.


Hoza, B., Smith, A. L., Shoulberg, E. K., et al. (2015). A randomized trial examining the effects of exercise on children with ADHD. Pediatrics, 135(3), e666-e677.


Chan, L. S., Ilieva, I. P., et al. (2023). Trauma and ADHD: Clinical Overlaps and Differentiation. Journal of Traumatic Stress Disorders & Treatment.


Ilieva, I. P., Chan, L. S., et al. (2020). Traumatic Brain Injury and ADHD: Reviewing the Evidence for Overlap. Journal of Neuropsychiatry.


Halstead, M. E., et al. (2015). Neuropsychological Testing Following Traumatic Brain Injury. Brain Injury Professional.


Afshari, A., Dearborn, D. G., et al. (2019). Mold Toxicity and Its Effects on Cognitive Functioning. Indoor Air Quality Journal.


Dearborn, D. G., Afshari, A., et al. (2008). Cognitive Impairment due to Mold Exposure: Case Studies and Implications. Clinical Environmental Health and Toxic Exposures.


Centers for Disease Control and Prevention. (2023). Mold and Health. [Online]


Bennet, L., Dwelly, M., et al. (2017). Tickborne Diseases and ADHD: A Possible Link. Journal of Infectious Diseases.


Mead, P., et al. (2020). Lyme Disease and ADHD Symptoms. Emerging Infectious Diseases.


Biederman, J., Monuteaux, M. C., et al. (2017). Gut Health and ADHD: Exploring the Connection. Journal of Pediatric Gastroenterology and Nutrition.


Pennell, M., El-Rashidy, O., et al. (2022). Food Sensitivities and ADHD: A Review. Journal of Allergy and Clinical Immunology.


El-Rashidy, O., Pennell, M., et al. (2020). Nutritional Intervention in ADHD: The Role of the Gut-Brain Axis. Nutrition Reviews


Meltzer-Brody, S., et al. (2016). Thyroid Disorders and ADHD: Clinical Implications. Journal of Clinical Endocrinology & Metabolism.


National Institute of Mental Health. (2023). ADHD: Diagnosis and Treatment. [Online]

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