James B. Parish, DC Atrium Health Services St Louis, MO


James B. Parish, DC Atrium Health Services St Louis, MO
James B. Parish, DC
Atrium Health Services
St Louis, MO
 James B. Parish, DC
 Logan Graduate, 2008
 SOT Practitioner with Penchant for Nutrition
 Throughout the presentation, both conditions will be
referred to as ADD.
 3-5% of children suffer from ADD
 4% of adults
 Used to think that it was strictly a childhood disorder,
new thinking is that it is likely carried into adulthood.
 Adult ADD is not recognized by the DSM-IV
 Most cases of Adult ADD will reveal undiagnosed ADD
as a child
 Occurs 2-4 times more frequently in boys than girls
 Anxiety and depression are common co-morbid
conditions with ADD.
 Adult symptoms include
 Inability to initiate tasks-Procrastinators
 Inability or difficulty with organization, breaking down large
 Start a lot of projects but never finish them
 Never seem to “live up to their potential”
 Correlations have been drawn to being exposed to
smoking, alcohol use, street drugs, and pesticides inutero.
 Strong genetic component-like father, like son
 Three Predominate types
 Predominantly Hyperactive
 Six or more symptoms are of the hyperactivity variety and
less than six are in the inattentive type
 Inattention may be present, but it is not the defining feature
 Predominately Inattentive
 Six or more symptoms are of the inattentive variety and less
than six of the hyperactive type
 Combination
 More than six in each category
 Often fails to give close attention to details or makes careless mistakes
in schoolwork, work, or other activities.
Often has difficulty sustaining attention in tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish
schoolwork. Chores, or duties in the workplace (not due to
oppositional behavior or failure to understand instructions).
Often has difficulty organizing tasks and activities.
Often avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort (such as schoolwork or homework).
Often loses things necessary for tasks or activities (e.g. toys, school
assignments, pencils, books, or tools).
Is often easily distracted by stimuli unrelated to the subject or activity
being dealt with.
Is often forgetful in daily activities.
 Source DSM-IV
 Often fidgets with hands or feet or squirms in seat.
 Often leaves seat in classroom, office meetings or in other
situations in which remaining seated is expected.
Often runs about or climbs excessively in situations in which it is
inappropriate (in adolescents or adults, may be limited to
subjective feelings of restlessness).
Often has difficulty playing or engaging in leisure activities
Is often “on the go” or often acts as if “driven by a motor.”
Often talks excessively.
Often blurts out answers before questions have been completed.
Often has difficulty awaiting turn.
Often interrupts or intrudes on others (e.g., butts into
conversations or games).
 There is a correlation between mass of the brain and risk of
developing ADD
 Brain mass in total is decreased, but certain areas are more
pronounced than others
 Multiple studies suggest that the prefrontal cortex lags
behind the development of the rest of the brain in ADD
 Interesting due to it’s role in complex cognitive behavior and
moderating social behavior.
 This lack of development is also found, although to a lesser
extent, in the cerebellum.
 This is the likely rationale for omega 3 fatty acid therapy in
ADD patients
 Pesticide use is highly implicated in the development
of ADD.
 Organophosphates have been implicated in multiple
 Malathion is widely used in agriculture as well as fogging for
mosquito infestations.
 Chlorpyrifos is “one of the most widely used
organophosphate insecticides” according to the EPA. It is
most commonly used on cotton, corn, apples, and oranges. It
is known to cause neurological disorders, developmental
delays, and autoimmune disease.
Attention-Deficit/Hyperactivity Disorder and Urinary Metabolites of Organophosphate Pesticides
Maryse F. Bouchard, PhDa,b, David C. Bellinger, PhDa,c,Robert O. Wright, MD, MPHa,d,e, Marc G. Weisskopf, PhDa,e,f
+Author Affiliations
Departments of aEnvironmental Health and fEpidemiology, School of Public Health, Harvard University, Boston, Massachusetts;
bDepartment of Environmental and Occupational Health, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada;
Departments of cNeurology and dPediatrics, School of Medicine, Harvard University, and Boston Children's Hospital, Boston, Massachusetts; and
eChanning Laboratory, Department of Medicine, School of Medicine, Harvard University, and Brigham and Women's Hospital, Boston, Massachusetts
 OBJECTIVE: The goal was to examine the association between urinary concentrations of
dialkyl phosphate metabolites of organophosphates and attention-deficit/hyperactivity
disorder (ADHD) in children 8 to 15 years of age.
 METHODS: Cross-sectional data from the National Health and Nutrition Examination
Survey (2000–2004) were available for 1139 children, who were representative of the
general US population. A structured interview with a parent was used to ascertain ADHD
diagnostic status, on the basis of slightly modified criteria from the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition.
 RESULTS: One hundred nineteen children met the diagnostic criteria for ADHD.
Children with higher urinary dialkyl phosphate concentrations, especially dimethyl
alkylphosphate (DMAP) concentrations, were more likely to be diagnosed as having
ADHD. A 10-fold increase in DMAP concentration was associated with an odds ratio of
1.55 (95% confidence interval: 1.14–2.10), with adjustment for gender, age, race/ethnicity,
poverty/income ratio, fasting duration, and urinary creatinine concentration. For the
most-commonly detected DMAP metabolite, dimethyl thiophosphate, children with
levels higher than the median of detectable concentrations had twice the odds of ADHD
(adjusted odds ratio: 1.93 [95% confidence interval: 1.23–3.02]), compared with children
with undetectable levels.
 CONCLUSIONS: These findings support the hypothesis that organophosphate exposure,
at levels common among US children, may contribute to ADHD prevalence. Prospective
studies are needed to establish whether this association is causal.
Impact of Prenatal Chlorpyrifos Exposure on Neurodevelopment in the First 3 Years of Life
Among Inner-City Children
Virginia A. Rauh, ScDa, Robin Garfinkel, PhDa, Frederica P. Perera, DrPHa, Howard F. Andrews, PhDa, Lori Hoepner, MPHa, Dana
B. Barr, PhD, DLSb, Ralph Whitehead, MPHb, Deliang Tang, DrPHa,Robin W. Whyatt, DrPHa
+Author Affiliations
aColumbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, New York
bNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
 OBJECTIVE. The purpose of this study was to investigate the impact of prenatal exposure to
chlorpyrifos on 3-year neurodevelopment and behavior in a sample of inner-city minority children.
 METHODS. As part of an ongoing prospective cohort study in an inner-city minority population,
neurotoxicant effects of prenatal exposure to chlorpyrifos were evaluated in 254 children through the
first 3 years of life. This report examined cognitive and motor development at 12, 24, and 36 months
(measured with the Bayley Scales of Infant Development II) and child behavior at 36 months
(measured with the Child Behavior Checklist) as a function of chlorpyrifos levels in umbilical cord
 RESULTS. Highly exposed children (chlorpyrifos levels of >6.17 pg/g plasma) scored, on average, 6.5
points lower on the Bayley Psychomotor Development Index and 3.3 points lower on the Bayley
Mental Development Index at 3 years of age compared with those with lower levels of exposure.
Children exposed to higher, compared with lower, chlorpyrifos levels were also significantly more
likely to experience Psychomotor Development Index and Mental Development Index delays,
attention problems, attention-deficit/hyperactivity disorder problems, and pervasive developmental
disorder problems at 3 years of age.
 CONCLUSIONS. The adjusted mean 36-month Psychomotor Development Index and Mental
Development Index scores of the highly and lower exposed groups differed by only 7.1 and 3.0 points,
respectively, but the proportion of delayed children in the high-exposure group, compared with the
low-exposure group, was 5 times greater for the Psychomotor Development Index and 2.4 times
greater for the Mental Development Index, increasing the number of children possibly needing early
intervention services.
 Recommendations per clinical reference guide
 OPC Synergy (2)
 Cataplex G (6)
 Min-Tran (6)-If hyperactivity is present
 Bacopa Complex (3)
 EPO (3)
 Rhodiola & Ginseng (3)
 Reduce carbohydrate intake
Evaluation of total oxidative status in adult attention deficit hyperactivity disorder and its
diagnostic implications.
Selek S, Bulut M, Ocak AR, Kalenderoğlu A, Savaş HA.
Harran University, Faculty of Medicine, Psychiatry Dept., Yenisehir Kampus, 63300 Sanliurfa, Turkey.
 Adult Attention Deficit Hyperactivity Disorder (A-ADHD) is one of the psychiatric
disorders which awareness is growing. The exact causes of A-ADHDare still unknown. In
addition to neurochemical and neuroanatomic disorders, genetic and environmental
factors are discussed in its etiology. In our study, we aimed to evaluate the oxidative
status of A-ADHD patients and investigate whether oxidative metabolites can be used as
diagnostic tools or not in A-ADHD. Blood samples were taken from enrolled 50 AADHD patients and 31 controls in appropriate way and Total Antioxidative Status (TAS),
Total Oxidative Status (TOS), and Oxidative Stress Index (OSI) were studied in Harran
University Biochemistry Labs. Results were compared between groups and ROC curve
was drawn in order to evaluate diagnostic performances. Patients' TAS, TOS and OSI
were significantly higher than controls. There was not a significant difference between
comorbid cases and only A-ADHD patients in terms of measured values. A-ADHD can be
predicted for TOS over 9.8575 μmol H(2)O(2) Eqv./L level with 86% positive predictive
value and %100 negative predictive value. In A-ADHD, oxidative balance is impaired.
High antioxidant levels may be compensatory against the oxidant increase. Oxidative
parameters may be used in A-ADHD diagnosis.
Copyright © 2011 Elsevier Ltd. All rights reserved.
 In addition to the antioxidant effects of OPC, we also
know it is useful in the support of circulation in the
 Possible reason for decreased glucose utilization in the
brain with ADD is less than optimal circulatory
development of the brain and thus why we see
improvement with OPC Synergy
 Increase in concentration and cognitive ability
The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects.
Stough C, Lloyd J, Clarke J, Downey LA, Hutchison CW, Rodgers T, Nathan PJ.
Neuropsychology Laboratory, School of Biophysical Science and Electrical Engineering, Victoria, Australia.
Extracts of Bacopa monniera have been reported to exert cognitive enhancing effects in animals.
However, the effects on human cognition are inconclusive.
The current study examined the chronic effects of an extract of B. monniera (Keenmind) on
cognitive function in healthy human subjects.
The study was a double-blind placebo-controlled independent-group design in which subjects were
randomly allocated to one of two treatment conditions, B. monniera (300 mg) or placebo.
Neuropsychological testing was conducted pre-(baseline) and at 5 and 12 weeks post drug
B. monniera significantly improved speed of visual information processing measured by the IT task,
learning rate and memory consolidation measured by the AVLT (P<0.05), and state anxiety
(P<0.001) compared to placebo, with maximal effects evident after 12 weeks.
These findings suggest that B. monniera may improve higher order cognitive processes that are
critically dependent on the input of information from our environment such as learning and
 Bacopa is a powerful brain tonic and has evidence for
use in a wide range of conditions
 A powerful antioxidant that has been proven to reduce
amyloid deposits in Alzheimer patients.
 Has been shown in multiple studies to enhance and
both memory formation and retention and improve
Phytomedicine. 2000 Oct;7(5):365-71.
Rhodiola rosea in stress induced fatigue--a double blind cross-over study of a standardized
extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy
physicians during night duty.
Darbinyan V, Kteyan A, Panossian A, Gabrielian E, Wikman G, Wagner H.
Department of Neurology, Armenian State Medical University, Yerevan. [email protected]
The aim of this study was to investigate the effect of repeated low-dose treatment with a
standardized extract SHR/5 of rhizome Rhodiola rosea L, (RRE) on fatigue during night
duty among a group of 56 young, healthy physicians. The effect was measured as total
mental performance calculated as Fatigue Index. The tests chosen reflect an overall level
of mental fatigue, involving complex perceptive and cognitive cerebral functions, such as
associative thinking, short-term memory, calculation and ability of concentration, and
speed of audio-visual perception. These parameters were tested before and after night
duty during three periods of two weeks each: a) a test period of one RRE/placebo tablet
daily, b) a washout period and c) a third period of one placebo/RRE tablet daily, in a
double-blind cross-over trial. The perceptive and cognitive cerebral functions mentioned
above were investigated using 5 different tests. A statistically significant improvement in
these tests was observed in the treatment group (RRE) during the first two weeks period.
No side-effects were reported for either treatment noted. These results suggest that RRE
can reduce general fatigue under certain stressful conditions.
PMID: 11081987 [PubMed - indexed for MEDLINE]
 Rhodiola has been clinically proven to improve focus
and concentration in students.
 Likely done by regulation of serotonin and dopamine
levels in the brain.
 Reduction of fatigue and overall sense of well being are
also reported effects with Rhodiola use.
 Coupled with Korean Ginseng in Mediherb’s Rhodiola
and Ginseng
 Ginseng has been shown to improve cerebrovascular
perfusion, memory retention, and reduce stress
Omega-3 fatty acid treatment of children with attention-deficit hyperactivity disorder: A randomized, double-blind,
placebo-controlled study
Stacey Ageranioti Bélanger, MD PhD,1 Michel Vanasse, MD,1,2 Schohraya Spahis, MSc,2,3 Marie-Pierre Sylvestre, MSc,4 Sarah Lippé, PhD,1François l’Heureux, MSc,1 Parviz
Ghadirian, PhD,3 Catherine-Marie Vanasse, PhD,1 and Emile Levy, MD PhD2,3
of Pediatrics, CHU Ste-Justine, Montréal, Québec; 2Research Centre, CHU Ste-Justine, Montréal, Québec; 3Department of Nutrition,
University of Montréal, Montréal, Québec; 4Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal,
Although several clinical trials have evaluated the impact of n-3 polyunsaturated fatty acid (PUFA) on patients with attention-deficit
hyperactivity disorder (ADHD), changes in plasma PUFA composition were not always assessed following n-3 supplementation.
Furthermore, no reports are available on the efficacy of n-3 PUFA in Canadian youth with ADHD.
To determine fatty acid (FA) composition, and the efficacy and safety of n-3 PUFA supplementation on ADHD clinical symptoms in
French Canadian primary school children.
FA differences between groups were observed in the 26 patients. Supplementation with n-3 PUFA resulted in significant increases in
eicosapentaenoic and docosahexaenoic acids in group A, while group B was enriched with alpha-linolenic, gamma-linolenic and
homo-gamma-linolenic acids. The n-3 PUFA supplement was tolerated without any adverse effects. A statistically significant
improvement in symptoms was noted based on the parent version of the Conners’ questionnaire from baseline to the end of phase 1,
and this amelioration continued from phases 1 to 2, although the latter changes from phases 1 and 2 were not statistically significant
in any of the subscales except for the subscale measuring inattention in group B. The improvement was greater in patients from
group A in phase 1 and in patients from group B in phase 2. A subgroup of eight patients (four in each group) displayed a statistically
significant clinical improvement following the administration of the n-3 PUFA supplement, particularly for the inattention and
global Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, total Conners’ subscales.
A subgroup of children with ADHD who used n-3 PUFA supplements achieved and maintained symptom control. The data of the
present study also supported n-3 PUFA safety and tolerability, but limited changes were noted in the FA profile in French Canadians
with ADHD.
 Given the evidence, case can be made for organic diet.
At bare minimum, need to stop buying conventional
dirty dozen foods and meat.
 Farmers sprays the corn, cow eats the corn, you eat the
 Food Colorings/preservatives must be eliminated.
 More evidence in literature for this than just about
anything else.
 Everyone gets this except the United States.
 Reduce Carbohydrate intake
 Self Explanatory
 Remove suspected allergens
 No matter how you test it, there is a likely allergenic
component that will show improvement once it is
 Digestive health status
 Trials with any or all of these is warranted. If there is no
or little response to treatment, look at digestive pillar
and address before moving forward.
 Toxic load status
 As demonstrated by the pesticide studies, external
toxins can play a large role in this disorder.
 Consider supplementing with SP Cleanse, AF Betafood,
and Livaplex to address these issues.
 If this is an adult, consider a full Purification Program.
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