Episode 46: Digesting ADHD

The content of this podcast has not been evaluated by Health Canada or the FDA. It is educational in nature and should not be taken as medical advice. Always consult a qualified medical professional to see if a diet, lifestyle change, or supplement is right for you. Any supplements mentioned are not intended to diagnose, treat, cure or prevent any disease. Please note that the opinions of the guests or hosts are their own and may not reflect those of Advanced Orthomolecular Research, Inc.

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Welcome to Supplementing Health, a podcast presented by Advanced Orthomolecular Research. We are all about applying evidence based and effective dietary lifestyle and natural health product strategies for your optimal health. In each episode, we will feature very engaging clinicians and experts from the world of functional and naturopathic medicine to help achieve our mission to empower people to lead their best lives naturally.

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[01:10] Cassy Price: If you are someone who suffers from frequent digestive problems you know the daily challenges and the potential embarrassments that come with these issues. IBD relief provides an innovative and effective combination of ingredients to help those with food sensitivities and intestinal inflammation to manage the symptoms and prevent exacerbation of the condition. Find relief today at your local retailer or online at AOR.ca

[01:30] Cassy Price: Welcome to Supplementing Health. Today we are joined by DR. Dawn Brown to discuss ADHD and the connection to the gut. Known as the MD with ADHD, Dr. Brown was diagnosed with ADHD herself while completing a child fellowship programme during her early thirties. As a result, she possesses a unique understanding of the frustrations surrounding treatment and the need for compassion in ongoing care. Welcome Dr. Brown.

[01:55] Dr. Dawn Brown: Thank you so much Cassy. It is great to be here on the platform. Thanks for having me on.

[02:00] Cassy Price: Having your own diagnosis of ADHD gives you a really unique advantage to treating your patients as you can sympathise with and fully understand what they are experiencing. So, did you have an interest in ADD and ADHD prior to your own diagnosis?

[02:15] Dr. Dawn Brown: I actually did not have a specific interest in ADHD. I had more of just a generalised interest in treating children and adolescence with mental health conditions. My interest in ADHD became more specific when I was in the second year of my actual private practice. I was an individual proprietor at a private practice, and I realised that there were not many resources in our community that would help parents of children, or even adults, manage their ADHD symptoms. I actually live in the fourth largest city in United States which is Houston, Texas. So even with that being stated there were a rarity of resources that would allow people to have a comfort and safe and appropriate management, so that’s when I started my own private practice called the ADHD Wellness Centre.

[03:09] Cassy Price: Okay. Awesome. For our listeners can you explain what the difference is between ADD and ADHD?

[03:17] Dr. Dawn Brown: Sure. ADHD stands for Attention Deficit Hyperactivity Disorder. ADD is Attention Deficit Disorder. So, ADHD has three sub types. When we look at the three subtypes there is ADHD predominately inattentive type which is formally known as ADD, alright? Then you have ADHD combined hyperactive type and ADHD hyperactive impulsive type. So, when we look under the umbrella of ADHD, ADD is the predominantly inattentive type and so it is only the change of nomenclature, the change of name, but it still exists. We treat ADHD the same as ADD and so there is really no specific difference other than how it is presented. ADHD predominantly inattentive type, also known as ADD is where people have distractibility and more inattentive focus. They may have forgetfulness. It is hard to stay attuned or attentive in meetings or in class, so primarily the difference is the actual symptoms that are more focused with ADHD predominately attentive type than ADHD combined or hyperactive impulsive type.

[04:39] Cassy Price: Okay. What causes ADHD? Is it a genetic condition or are there different elements of a child’s surrounding that can induce it?

[04:50] Dr. Dawn Brown: That is an interesting question. Research is still ongoing, but we do know it is multifactorial which means that there is a variety of causes that we are finding that relate to ADHD. So, in addition to genetics there are environmental causes. When we look at genetics, we look at parents and if there is a parent with ADHD there is anywhere from a 30-70% chance that their child may have ADHD, so it is not just based on genetics but it is also based on environmental causes such as in ureteral exposed smoking so if mom is pregnant and she is smoker that may increase the child’s risk, alcohol use in pregnancy, maybe nutritional deficiencies, low birth weight or premature births. Brain injuries we are finding may have a link to ADHD. So, there is a variety of genetic and environmental factors that may contribute to the actual condition.

[05:45] Cassy Price: What age are kids usually diagnosed?

[05:50] Dr. Dawn Brown: You know I actually evaluate children as young as preschool. The reason is because they are in school. I often see that when kids are in school and they are around other kids when they have to stay attentive or have to sit down, that that becomes a problem not just for the child but for the environment. They may be distracting other students or they may actually not be learning optimally, so I have evaluated children for ADHD as young as preschool so that could be three years old but I don’t necessarily start treating until age five or six because, for me professionally and personally, the brain is developing expeditiously and so even though there are certain studies that how effective certain treatments can be, such as medication management, usually around that time I would start with behavioural management and maybe make a referral to a behavioural specialist but yeah children from this age can usually come to my office when they are challenged with severe and frequent behavioural concerns. However, diagnosing ADHD in younger children, around age three to five, can be difficult because many preschool children naturally have some symptoms of ADHD also a child’s behaviour at developmental age can change very rapidly during preschool years, so it is very important that even if the diagnosis is established that young, that there is ongoing evaluations with that child and the child’s family.

[07:16] Cassy Price: Yeah, that makes sense. Now ADD or ADHD are terms that people kind of throw around flippantly and I think because of that there is, to a certain degree, a perception that it is a ‘catch all’ diagnosis because you know someone gets distracted and they’ll be like “I’m so ADD” and it is said so flippantly whereas it is a real condition obviously that people are having to deal with. So, what are the signs and symptoms that actually are true to ADHD vs someone that is just using it as a kind of offhand phrase?

[07:52] Dr. Dawn Brown: That is a very good point that you made. So, I want to add to that before I get to the certain science because children are very naturally full of energy, right? Highly talkative, impulsive, it is very typical for a child to require reminders for completing a task or even needing assistance with locating a toy that they misplaced, and encounter challenges with sitting still at the dinner table. So, you are certainly right when you say that or describe it. I will say that ADHD is the most common mental health disorder or condition in children, but it does not mean that the majority of children have it. One way to know if your child has ADHD is through a series of evaluations with a mental health professional that is trained to evaluate this condition and although they may have some symptoms that may look like ADHD it may be something else which is why it is important to connect. Commonly seen in children with this condition shows more specific symptoms of inattention or hyperactivity or impulsivity. Again, the previous subtypes that I mentioned before. Symptoms must begin before age 12.

[8:52] Previously this was before age six. We found that, especially with females, symptoms were not necessarily as prominent or visualised as in boys. That does not mean that boys don’t have the predominant inattentive type such as daydreaming or looking off in space or looking at the teacher but thinking about other things or distracted by their own thoughts that are going on in their head. We were seeing that a lot of girls were having these conditions and therefore the condition of diagnosis was missed so now we saw that with older kids around the age of 12 that these symptoms, that is what actually became a little bit more prominent as they neared toward preadolescent age. So, that is one of the reasons why the diagnostic criteria went from age six to 12. The interesting phenomenon is that symptoms have to be consistent. They must occur for more than six months in at least two settings. So, if we think about children, those main two settings that kids spent the most time in is at home or at school. We think about adults it is usually at home and at work or school sometimes. Usually what a doctor does is compare the symptoms, of particularly child behaviour, with other children the same age.

[10:10] So, that is subjective. A subjective evaluation as well. So, not only subjective evaluations are taking place with the doctor, but the doctor may also provide what we call rating scales to be given to teachers, coaches, grandparents…any adult that knows that child very well as well as the child might actually fill out some forms himself or herself to get an understanding objectively if this condition is prominent with that particular child. Children with ADHD have major problems in one or more areas of their lives such as school performance but also, we see some problems in friendships and relationships with family. Again, they must interfere with the child’s ability to function. So, not just at school, not just at home, but also in friendship and social circles. So, sometimes if they are involved in a soccer game and they are not paying attention to the coach or they forget to play then if it consistent that this is a problem for at least six months then we are able to establish that diagnosis. So, there is a lot that goes into this and I do want to warn parents and even adults who are going online and doing assessments that take five minutes, that is not enough to establish that diagnosis. That is actually as risk of misdiagnosis. Teeny tiny words that you see at the bottom of those online forms is that you need to seek a professional and this is the reason why – because we have certain diagnostic criteria that goes into how we establish diagnosis because it can be a chronic condition.

[11:47] Cassy Price: And so earlier you were talking about how children’s brains are still developing, right? So, someone who displays some tendencies in preschool or early ages may not necessarily end up with a true diagnosis. Does that mean that a kid could actually grow out of ADHD or that it could be cured?

[12:06] Dr. Dawn Brown: No, as I said it can be a chronic condition and I want to refute that it will be chronic condition. ADHD does not -you can’t grow out of ADHD. It doesn’t go away and you don’t just develop it in adulthood. It has always been there. You are born with the condition and so when I was diagnosed at age 31, I was in denial. I actually saw three professionals because I just did not believe that all of a sudden this condition could come on and here I am in my psychiatry fellowship programme and I opened up a clinic for ADHD kids, so even in my own denial I could not believe that this was something that I had. Other than denial it became my sense of normalcy, so it was normal for me to get up early in the morning at 5 am and start my day. It was normal for me to study for five or six hours straight with intermittent break periods. It was normal for me to check on things over and over again because I knew I would forget. I developed a pattern of normalcy that was normal for me but maybe not for someone else. So, instead of using the word normal, instead of using the word crazy, I used the word what’s natural? What’s natural for the human being? What’s natural for the human mind? That’s important to recognise as well. So, it is not natural for someone to have these symptoms and function optimally. So, it is something that you don’t grow out of. It is always with you. It may become more prominent like it did for me when I actually went into medical school and I failed my boards five times in medical school. Then when I was treated then I aced my boards and scored the top 10% of my ring boards for four years after I graduated. It can be a difference between fail and succeeding, it can be a difference form a person not performing optimally to performing their super best and so this is something that truly is something that can be life changing. It should be treated as such. It is a condition that does not go away. It is important that if you find or feel or suspect that you do, or your child has ADHD, there is no harm in being evaluated for the condition.

[14:28] Cassy Price: Your situation actually made me think that cultural norms would probably influence how quickly you might notice as well, right? If you are in maybe even a corporate culture where it is conducive to what is natural for you, you may not notice those symptoms the same way as if you are in a different corporate or educational culture that kind of clashes or goes against what you would normally do or find natural for your situation.

[14:58] Dr. Dawn Brown: That’s definitely right and I would even start back when my parents put me into my Montessori school. I started Montessori school, which is a creative school where the students are not necessarily doing the same course and they are not taught the same. It’s like you are on your own creative journey and it is very hands on. Then I went to a public school in a magnet programme. If you could look at the structure, the pace, the more one on one training even at an early age this is something that could have been masked, you know? Unfortunately, my mom passed 13 years ago so she’s not here, but she was into academics, she was an educator, she was a Dean of Students so she picked my teachers so even having that kind of influence really could have guarded me and actually masked the condition. Then here I am in college, I attended Xavier University in Louisiana and it was a very small private catholic college as well. Then I went to Saint Louis University School of medicine, which is a catholic- you see where I am going with this? There is a lot of structure which actually allowed me to function optimally and so even in school with that structure I was able to succeed. It’s not atypical or unusual for many people with ADHD to be entrepreneurs. I’m a serial entrepreneur. I’ve owned three businesses because I do things on my own time. I have the autonomy to schedule my own schedule and structure things how I want and function within my own optimal level of functioning as well. So, yes you are exactly right. When you are in corporate America and the structure is already pre-created for you, yes you may be able to be optimally functioned. But being an entrepreneur, when you have to schedule your ownschedules, sometimes we struggle but we also function optimally when we know that our condition is managed as well. It is an interesting condition that I also call the ‘amazability’. I have coined that term because I don’t look at it as a disorder. I look at it as a condition that if it is managed properly it really can be amazing for people.

[17:15] Cassy Price: Awesome. Knowing that those environmental factors can really influence the condition, do lifestyle factors like exercise, sleep, diet also make a difference for people with ADHD?

[17:29] Dr. Dawn Brown: Most certainly. It makes a difference for every one of us with or without ADHD. It’s how we function healthily. We have to eat, and we have to sleep. Those are two things that we cannot avoid, right? Sleeping well and having fulfilment of sleep is important. It’s interesting because some of the idiosyncrasies of ADHD, a lot of us have problems going to sleep because we are very creative people. We like to stay up at night. It is quiet at night if you live in a household full of people. It is our time to focus and a lot of us just become very creative. We are motivated and we have a lot of energy and we do things very well, so you find a lot of us are night owls that people refer to. It is also important that we sleep as well because when we don’t sleep it does interfere with our ability to have great clarity of thought, good mood stability and being on point and in tune to time and task management and our productivity and performance can be impacted as well. Same thing with what we eat. What we eat is important. It’s important that we get a well-balanced meal that is conducible to good health, our immune system and that we feed our personality. I always tell the kids I see that it is important to eat breakfast because you have to feed your personality. Unfortunately, a lot of my kids don’t eat breakfast because they are running late at the beginning of the day trying to get to school. The condition can interfere with what we are supposed to do which can be healthy for us but what I do with my patients, I do ADHD coaching with them as well, behaviour management techniques such as this to train them that it’s okay, we need to start at night to get ready for the next day. So there are simple things that we can do to get that good diet and exercise and sleep. Exercise is also important. I mention that in my book ADHD Lifestyle Series that exercise is so important, and I love Karate especially for my kids. It’s a good healthy way to stay fit, get that heart pumping, it’s good for discipline and an award system with the colours of the belt and then peers.. Exercise is a really good task that we can definitely use for healthy lives, but it’s shown to be beneficial for ADHD and make a huge difference.

[20:03] Cassy Price: Awesome. I love that you said that you are feeding your personality. I think that is so awesome and it’s true really because the food we eat does influence if we are energetic or lethargic or maybe if you are grouchy, you know? So, I think too when you have a condition like ADHD that already has an impact on how your brain is firing and the way you’re thinking and interacting with your environment it is important to keep that in mind when you are choosing the foods that you are choosing. I absolutely love that, and I am probably going to start adopting that if you don’t mind.

[20:41] Dr. Dawn Brown: Please do. Please do.

[20:45] Cassy Price: On that topic we’ve learned a lot more about that gut brain connection right? That when we are feeding ourselves, we are doing more than just nourishing our muscles and our cells but we are also nourishing our brain and the processes that it handles as well. We have learned about the microbiome and obviously science is still exploring that and learning all the roles that it actually plays within the body, but I was curious, if there any research available yet that speaks to that connection between the gut and ADHD specifically?

[21:20] Dr. Dawn Brown: You know research about that brain health with ADHD and other disorders is promising and emerging but not fully proven like you were saying. We know that there is a connection, but the full impact of that connection is not currently entirely established but it appears that our immune system is playing a huge role in overall health of our body and brain. Our immune system we know fights off infections, right? We develop these white blood cells that help fight off infections that we may encounter but we have also found out that our gut microbes are so important that they may be influencing or even help programming our immune function. So, I find this will be awesome research. I think there is a strong connection to the gut immune system in how our cognition and how we think and behave. There is a strong connection. I will say that each individual’s bacterial makeup is very different and so there are chronic diseases such as ADHD that actually can be traced back to our gut health. So, for this reason a person with ADHD may experience the effects of an unhealthy gut. So, the nerve that connects the gut to the brain, drive brain circuitry involved in our learning and how we memorise information as well as how we manage and regulate our emotions. So, ADHD since it involves challenges with ability controlling emotions sometimes or a child forgets to bring schoolbooks, like our memory part, or even an adult that may be acting without considering the consequences of their action, the importance of keeping a healthy gut, as healthy as possible is so important, because if our gut is not healthy, we are not healthy. All of these things are ongoing but yes there is some wonderful research out there that is showing us that the gut in how we moods, anxiety, cognition, even pain, how they are actually a role for the gut and microbes.

[23:36] Cassy Price: You mentioned the immune system there, so that made me start thinking about inflammation and we know inflammation is another thing that has been tied to a lot of chronic illnesses or health conditions. I was just curious, has inflammation been flagged at all to have an effect on ADHD?

[23:54] Dr. Dawn Brown: Yes Maam. I don’t know if you have heard about leaky gut or IBD, which is inflammatory bowel disorder? These conditions have an inflammation to them. The biggest problem is that they may be difficult to diagnose because there is not a specific criteria for leaky gut or specific criteria for IBD that comes with the plan but what we are finding is that there are certain symptoms or conditions that are associated with each of these medical conditions. So, for example I would refer to leaky gut because I am very interested in leaky gut syndrome because I see a lot of kids that actually may be presenting with this that come to me and they come to for behavioural problems and they come to me because they are not eating well, they have problems with memory or just problems with staying focused or sitting still. So, leaky gut is a variety of conditions in your body. One of the linings in your small intestines becomes damaged or undigested food leaks into your abdominal cavity. I know this sounds a little nasty or crazy, but this actually can lead to toxic body waste getting into your blood stream and guess where the blood stream goes? All over your body including your brain. So, not only is this caused by food, but it can be caused by a person taking antibiotics for a period of time, aspirin or even steroids because these things can irritate the lining of a person’s digestive system, right? So, leaky gut can also happen when your body reacts to the food that you eat so if your body develops an immune response against soy or gluten or even dairy products these can also invade the immune system as well such as producing systems such as diarrhoea, joint pain, chronic fatigue or even irritability. So, yeah Cassy I can go on and on to this because I am so fascinated with this because the reason why as a psychiatrist, we go to medical school so we can evaluate which medications can be helpful and part of that evaluations being a psychiatrist is that we have to know all parts of the body. We have to know the brain, the gut, how the heart responds, how the blood pressure responds to the medicines that we treat, even other medicines that people are taking. So, psychiatrists are fascinating because we don’t just focus on the mental part. We have to be very knowledgeable about all parts of the body. That’s why I wrote my book because it is not just all about medicine and treating this but if I can not just put a Band-Aid on the wound, but I can get to what is causing the wound, then I am all for it and that is partly why I wrote my book. So, is it that we can avoid certain foods?  Can we sleep better? Can we exercise better? All these things are so important, and they also help our immune system so yes there is a direct connection that we are finding.

[26:58] Cassy Price: The fact that the body is so interconnected is one of the things that I find most fascinating and exciting about it. Any symptom is never really the cause of just one pinpointed item, right? There is usually so many different factors at play and I think it is really cool that science, and healthcare in general, is starting to recognise that and go more of this holistic route where it is looking at, like you said, not just that mental health aspect but what other parts of your health are playing into that and how can we address your symptoms at their actual route cause rather than just mask them with medications or other treatments. So, speaking of diet. Outside of IBD and leaky gut, are there certain foods that can help reduce the symptoms of ADHD?

[27:55] Dr. Dawn Brown: Yes. I will say this. If you don’t mind if I can change that to strategies because I like to include foods. So, I would say that yes there are certain foods that can help minimise ADHD but don’t treat ADHD. They can help minimise the symptoms. So, sugar. I love sugar, I love sweets, I love chocolate so I could put myself right here at the forefront, I have moderate ADHD actually and I love sugar. Sugar doesn’t necessarily cause hyperactivity. It’s a myth. What studies have examined about this idea, they found that sugar does not cause the symptoms, but several studies have concluded that sugar may cause periods of hyperactivity in children followed by sedation and inactivity, so it is like a huge drop off. Sugar also impacts other aspects of health that we mentioned such as bloating and inflammation, cause weight gain, create cavities and other health issues related to ADHD. Now I also realise that sugar is in almost every product that we consume. It is also disguised in every product. Its glucose, sucrose, fructose, right? It is one ingredient that is hard not to eat and can be rather addictive. I crave the three c’s: cakes, cookies and chocolate, right?

[29:21] Cassy Price: Don’t we all?

[29:23] Dr. Dawn Brown: Don’t we all, right? So, there is sugars in everything we eat, it’s the reason. They want you to buy the product. They want you to buy their product. I noticed that when I was in my twenties, I included less sugar in my meal plans I actually lost weight and I felt great. I really felt great. So, all of those sugars are an ingredient that I crave, I am more conscientious of how it impacts my thoughts, my mood, my weight, as well as my overall functioning. Gluten. A myth is that gluten enriched foods can cause ADHD. No. The fact that for many years gluten free diets have been suggested for ADHD symptoms, studies I believe back in 2010 or 2011, it concluded that individuals with both celiac and ADHD disease saw an improvement in their ADHD symptoms following treatment for celiac disease, however; gluten free diets did not have an impact on ADHD symptoms if the child did not have celiac disease so there is no direct association with celiac disease and ADHD even though both conditions have been associated with food allergies. I wanted to include that here, not necessarily in minimising ADHD symptoms but a lot of people or a lot of parents are giving their children gluten free diets. Its not a bad idea but it doesn’t impact their ADHD unless they have celiac disease. That is the point that I wanted to make. Watch out for artificial colours and preservatives. I would say stay away from that. If it is a can and it has a date on it, throw it away. Shop from the outside of your grocery store, that is where the fresh items are. Try to stay away from the middle of the grocery store because that is where your cans and preservatives are. So, yes, artificial preservatives can cause ADHD? No, they can’t cause it but, what we are finding, is that there are certain sensitivities that kids with, we talked about leaky gut, some sensitivities to artificial colours and preservatives are found with ADHD so they may have an effect on increasing activity and focus difficulties, but they don’t necessarily cause the condition. They just may exacerbate the symptoms. There is another thing about organic provincial foods. Now, we are finding that preliminary research on pesticides may play a role in actually causing ADHD as one of their environmental factors, but this sort of relationship has not been confirmed. So, what I would recommend is using a veggie wash and choosing organic foods can help reduce pesticide exposure for children and also expecting moms. Some of those themes can be helpful. If you don’t mind, I would just like to talk about a few strategies because I think that these strategies can also help improve gut health, right? That is the link that we are finding with ADHD. So, chew your food slowly. Chew your food slowly. This can actually maximise digestion by being in a relaxed state while eating particularly small bites and thoroughly chewing your food. I remember when I was young and in elementary school I was always being criticised for eating slow and being the last one. There is a reason. I was maximising my gut digestion and I didn’t even know it. This can actually help with gut health. Identifying inflammatory triggers from medications and foods is very important. So, like if you are giving your child something to eat that has something in it that they are allergic to, they may have diarrhoea or say their stomach hurts so that is causing an inflammatory trigger. Their gut is not necessarily absorbing it well so those are maybe markers. Then I would also say that for parents of children with ADHD that you are definitely not wrong steering your children toward a healthy diet early on. I love Greek yoghurt because it contains live cultures, but you also can be creative by incorporating it in your child’s diet. You can create smoothies, combine it with fruits. It is a great nutrient probiotic food supplement for your child that has live cultures in it. Also, include meat in their diet but just don’t eat too much red meat. More like fish, like mackerel or salmon. They are very good options for a kid diagnosed with ADHD. Try to make sure that their plate is colourful. I mentioned that in my book too. Make sure the plate is colourful and make sure they have plant based and organic foods are ideal. Eating less artificial foods and colours and additives and refined sugars that will not cause them to have hyperactivity but also those things, if you create a healthy balanced colourful plate, it will definitely decrease the risk of this overgrowth of these microbes that we were talking about before and lead to a healthy balance of having these microbes in the gut. Taking supplements are great, Flintstone Supplements are really good for any kiddo. It is not all about food, but it can be about stress so make sure that stress is maintained, make sure that you balance your day as much as possible.

[34:20] Cassy Price: Awesome. Those are awesome tips that you have shared there. I think they are good for anyone not even just kiddos with ADHD, but it is just for a healthy balanced lifestyle, they are great tips to incorporate. You mentioned your book, do you mind sharing the title and where people can find that?

[34:35] Dr. Dawn Brown: Sure. It called the ADHD Lifestyle Series Volume 1: Secrets from an MD with ADHD. Building Balanced Meals and Exercise Routines for Children. You can actually find my book on my website. That is www.drdawnpsychmd.com

[35:00] Cassy Price: Fantastic and is your website the best place for them to get a hold of you as well if they want to work with you?

[35:05] Dr. Dawn Brown: Yes mam. There is a contact form on my website, and I will look forward to answering any questions or addressing any concerns and working with people who are all about making this a condition for our kids and adolescence and adults, that we are going to change this so called disability in an ‘amazability’.

[35:29] Cassy Price: Fantastic. Well thank you so much for taking the time to chat to me today and share your expertise. I think it is a really great conversation that we have had and something that affects, like you said, so many different people, both adults and children, and so I really appreciate you taking the time to share your knowledge with myself and our listeners today.

[35:47] Dr. Dawn Brown: Thank you for having me I really do appreciate it and I had a wonderful time with you.

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