Posts Tagged ‘science’

ADHD; Coffee, Tea or Me.

July 3, 2012

Coffee, Tea or Me was a book about Stewardesses who offered themselves up to serve customers in the airline business in the sixties. Seems the author thought no one was appreciating their efforts to serve patrons and all their customers thought about was their sexual fantasies.  It  is not like I believe anyone should have sexual fantasies about a sixty-seven year old man, I just feel under appreciated for describing  the future of the 11 million children diagnosed with ADHD or ADD.

I never predict a bleak future for those with ADD/ADHD. As a matter of fact I consider my 67 years on earth as fun with an adoring wife who died too young, two lovely successful children and three grandchildren that I adore. The only thing which prompts me to explore the issue at this time is that at least two of the three grandchildren have full blown ADD/ADHD as does my son-in-law. I am not trying to solve the world’s problems nor sell supplements, I am just trying to leave a legacy of information that would allow my family to live drug free and cope in a world dominated by office jobs.

So far, I have my family and a half dozen other followers who want to know the future of a lifetime of unmedicated ADD/ADHD and 10,999,990 who are ignoring their future and twice that number of parents who remain uninformed about the future of their children. Oh well, I still feel compelled to seek the solutions and document the path of ADD/ADHD just for my granddaughters alone as it has been a heck of a roller coaster ride for me dominated by love, romance and a sense of adventure. Some of it has been troublesome, some has been good, some unique but all has been one heck of an adventure.

ADHD, Obesity, and Chronic Pain, Correlations and Causation!

July 2, 2012

 

Subjective Pain Measurement Scale

I apologize for the length and complexity of this discussion, but there is very little in the scientific Literature that studied ADD/ADHD and Chronic Pain. All I could find was one technical article, yet if you go to the bulletin boards and forums, there are many individuals begging for help. Just as obesity programs fail for those with ADD/ADHD, I suspect that Chronic Pain Treatments will be difficult for this unique subgroup with out working to resolve all three issues, ADHD, Obesity, and Chronic Pain.

Science Daily reported “A clear association between obesity and pain — with higher rates of pain identified in the heaviest individuals — was found in a study of more than one million Americans published January 19 in the online edition of Obesity. In “Obesity and Pain Are Associated in the United States,” Stony Brook University researchers Arthur A. Stone, Ph.D., and Joan E. Broderick, Ph.D. report this finding based on their analysis of 1,010,762 respondents surveyed via telephone interview by the Gallop Organization between 2008 and 2010.

Now from a marketing perspective, telephone surveys have the greatest incidence of error and this may account for the lower National rate of obesity reported in the study with only 28% claiming a height and weight indicating obesity.  Now without interviewing people in person or providing extensive education on the happy face pain scale, I am not certain how they reached the conclusion that “finding suggests that obesity alone may cause pain, aside from the presence of painful diseases [associated with obesity]”

“Interestingly, the pain that obese individuals reported was not driven exclusively by musculoskeletal pain, a type of pain that individuals carrying excess weight might typically experience.”

“Drs. Broderick and Stone also suggest that there could be several plausible explanations for the close obesity/pain relationship. These include the possibility that having excess fat in the body triggers complex physiological processes that result in inflammation and pain; depression, often experienced by obese individuals, is also linked to pain; and medical conditions that cause pain, such as arthritis, might result in reduced levels of exercise thereby resulting in weight gain. The researchers also indicated that the study showed as people get older, excess weight is associated with even more pain, which suggests a developmental process.”

Now the implication is clear, lose weight, grow younger and all your aches and pains will disappear. But the underlying assumption, the so called jump from conjecture to conclusion, is that obesity causes pain in some yet to be discovered but currently unknown ” complex physiological processes.” That does not sound like a true scientific explanation but more like junk science at it’s worse.

In a very well researched paper by E. Amy Janke, PhD;Allison Collins, PhD;and Andrea T. Kozak, PhD entitled “Overview of the relationship between pain and obesity: What do we know? Where do we go next?” the authors point out that there are many different types of pain including lower back pain, lower joint pain and generalized pain and their is no simple direct relationship between weight loss and reduced pain.

They summarize dozens of studies and a sample is presented below and represents both a lack of improvement for some pain and for others dramatic and lasting improvement especially for pain in the lower limbs.

In general, “Few studies examine both pain and weight as primary outcomes, and variability in measurement makes comparisons and conclusions difficult… Methodological differences among studies make conclusions about the influence of weight loss treatment on pain tentative at best. One issue relates to the samples used in the research. Samples in the reviewed studies represented potentially very different populations, thus making comparisons across studies difficult. Whereas some  researchers recruited based on overweight/obesity status, others selected individuals based on type or severity of pain condition in addition to weight.

They mention one, “early review of seven studies, found no evidence to support the recommendation of weight loss to treat Lower Back Pain [LBP.]

They ask, “How can we know so much about overweight/obesity and LBP and still know so little?  One answer to this question is that perhaps the relationship between the two is much weaker than previously hypothesized. A direct causal relationship between weight and LBP may or may not exist; indeed Leboeuf-Yde et al.’s meta-analysis certainly suggests that the relationship, if present, is weak

On the other hand, “Being overweight is a risk factor for development and progression of Osteoarthritis [OA] in the knee and hip, and possibly development of OA in the hand.  Weight loss is recommended for overweight persons with OA. Even being slightly overweight may increase your risk for developing knee OA.”

“However, other studies that have examined lifestyle interventions, such as enrollment in Weight Watchers and increased physical activity, traditional aerobic activity versus lifestyle physical activity, and diet and exercise treatment versus control,found no significant effect on bodily pain sub-scale scores despite significant improvements in physical functioning.”

In still another study, “Although the diet only group experienced greater weight loss compared with the healthy lifestyle group, no pain-related improvement was evident. In the exercise-only group, the only significant improvement was in mobility. However, the diet and exercise group had significant improvement in physical functioning, self-reported pain, mobility, and weight.”

Similarly another study “found that without exercise, weight loss alone did not lead to significant improvement in pain or mobility among overweight/obese individuals with knee OA”

In a different cited study, “the treatment group evidenced improvement in several aspects of Quality of Life and maintained an average weight loss of 13.9 percent of baseline weight. Improvement in bodily pain was only temporary and no longer evident at 4-month follow-up.”

Clearly the results bounce all over the place between some improvement and no improvement at all. In a very unique manner, there is no discussion of ADHD in any of the studies despite the fact that one third of Obese people suffer from ADHD and the greater the obesity, the greater the chance that the person also has ADD/ADHD.

But some times practitioners and researchers really do get it right. In a 2006, paper by Michael S. Kaplan and Leah R. Kaplan, entitled Why Do Chronic Pain Patients Have Multiple Accidents?, the authors explored the relationship between ADHD and Chronic Pain. The underlying assumption is that people with more physical trauma events have more chronic pain.

According to their paper, “A retrospective review of 460 random patients during a 6-month period included new and existing chronic pain patients. Our results preliminarily identified a trend in patient’s histories, characterized by anxiety problems and depressive symptoms, coupled with a family history of ADHD… The preliminary data support the hypothesis that chronic pain patients have a greater incidence of ADHD than might be expected and more importantly. We do not believe there are any previously published reports suggesting a correlation of ADHD with chronic pain resulting from increase incidence of accidents.”

There is ample evidence linking ADHD to obesity by people self medicating with food to elevate their dopamine levels and have their minds work in a normal manner and trauma links ADHD to chronic pain. but there is more to the relationship than that.

Recent research has documented the devastating effect that Chronic Pain has on the brain of a healthy person. For those suffering Chronic pain which had lasted six months or more, “researchers found abnormal brain activity during an attention-demanding cognitive task. They also found one region of the brain, was thinner in those with chronic pain compared to the healthy patients. This area of the brain plays a key role in mood, social judgment, short-term memory and higher-order thinking.

After the patients had corrective surgery for their medical conditions, the group of pain researchers from McGill University and the McGill University Health Center found that relieving pain actually causes physical brain changes they can see on a brain scan. During the cognitive test, the differences that the researchers had observed in brain activation in the first round of tests disappeared for eleven people in the group who had successful surgery. . Three of the 14 treated patients after treatment reported worse back pain or disability six months later. When researchers looked at their brain scans, their gray matter had not regenerated itself at all.

“Our results imply that [successfully] treating chronic back pain can restore normal brain function,” the authors conclude in their study, which appears in the Journal of Neuroscience.

In an article on Rewiring the Brain to Ease Pain in the Wall Street Journal,  Sean Mackey, chief of the division of pain management at Stanford, and his colleagues were just awarded a $9 million grant to study mind-based therapies for chronic low back pain from the government’s National Center for Complementary and Alternative Medicine  Some 116 million American adults—one-third of the population—struggle with chronic pain, and many are inadequately treated, according to a report by the Institute of Medicine in July.

According to the article, “one of Dr. Mackey’s favorite pain-relieving techniques is love. He and colleagues recruited 15 Stanford undergraduates and had them bring in photos of their beloved and another friend. Then he scanned their brains while applying pain stimuli from a hot probe. On average, the subject reported feeling 44% less pain while focusing on their loved one than on their friend. Brain images showed they had strong activity in the nucleus accumbens, an area deep in the brain involved with dopamine and reward circuits.

So research has finally come full circle and linked ADHD, Obesity and Chronic Pain. The same rewards that ADD/ADHD sufferers developed to stimulate dopamine production when self-medicating to think normally and function in our modern world are the same rewards that can be used to self medicate and mitigate the damaging effects of Chronic Pain.  Somehow, that result doesn’t surprise me.

Growing out of ADHD: An Erroneous Concept

June 24, 2012

I am pretty much intolerant of junk science, shoddy research and uninformed opinions expressed as fact. Since the web is a total democracy, the banal comments following a well researched intelligent discussion on CNN or other well researched sites drive me nuts because everybody treats them as equally important to the main article and in a web democracy, everybody’s point of view is important even if it is ill informed and the person is a 17 year old cyber bully. However, that mini-rant is not the subject of today’s post.

While researching the current narrow topic of sexual addiction and ADHD, I was delighted to find a paper entitled  “Sexual Addiction and ADHD: Is There A Connection?” by Richard Blankenship and Mark Laaser published in 2004. This paper does an extensive review of scientific studies on the impact of ADHD on victims and the areas where scientific research is flawed or lacking. I believe that every person who has ADHD above the age of reason, every adult with ADHD and every person who has a child with ADHD should read this paper.

Unbelievable as it may seem to many this paper was written by two devout Christians. Blankenship is Director of North Atlanta Center for Christian Counseling, and Vice President of American Association of Certified Christian Sexual Addiction Specialists. Laaser is Director of Faithful and True Ministries, Bethesda Workshops, and President of American Association of Certified Christian Sexual Addiction Specialists. Seems ADHD is not just a problem with poor people who eat nasty food and bad parents, it crosses all socioeconomic and spiritual boundaries.

Of course one of the most comforting pieces of research relates ADHD with above average intelligence, but I already intuitively knew that. Thus, it agrees with my unscientific assessment of me, my family and my friends all peas in the same Mendelian pod.

The slightly less comforting assessment is that ADHD is a chronic lifelong condition which is under treated resulting in a huge loss in adult potential. From their paper:

ADHD if left untreated will metastasize into other disorders. ADHD untreated has been known to become conduct disorder in adolescence and antisocial personality disorder in adult years (Gresham, Lane, & Lambros, 2000). Left untreated, ADHD can also develop into substance and behavioral addictions. A Utah study revealed that 24% of male inmates had ADHD. Other studies have shown that up to 40% of people in minimum security prisons have disorders on the ADHD spectrum (McCallon, 1998).

Perhaps no study has revealed the magnitude of treating ADHD along with co-occurring disorders than that of Dr. Paul Wender. Wender was establishing through his study that ADHD is a lifelong condition and people do not outgrow it. In his study, when inmates were paroled they entered a program for a period of 6 months to 2 years. They were given medication and placed under the care of counselors, doctors, and support groups. National recidivism rates for people released from prison are approximately 60%. The inmates in this study had a two year recidivism rate of only 10%. Only one individual in the study had a new criminal charge while a few had parole violations. Many of these men had been diagnosed as children with ADHD but treatment did not continue past grade school years.

Some were told that they would outgrow ADHD after the teen years. None were being treated into their 20’s. 18% had discovered crystal meth from the meth labs that now exist in abundance. The methamphetamine had given them the ability to remain calm and focused. 20% were medicating with marijuana and heroin. More severe discipline will not change ADHD.

The guilt and shame families feel as they visit relatives in prison is incredible. Way too many were advised by people in the school system, counseling, and psychiatry that ADHD was a condition they would outgrow. Or, in the words of Dr. McCallon, medical director in the Colorado department of corrections “if he outgrew it, what is he doing in my prison?”

I know I couldn’t have said it any better even though I took the liberty of breaking this up in to shorter paragraphs so those with ADHD could take the time to read it.

The Definitive ADHD Sugar Experiment on Children

June 14, 2012

What would I consider a definitive experiment on the effect of Sugar on children with  ADHD?

As previously discussed in Part 1, much of the work on sugar and hyperactivity is flawed and does not translate to real life parenting. In Part 2 of this series, I discussed my 65 year relationship with Sugar, Me and ADHD. My proposed experiment on Sugar, Children and ADHD is based on real scientific evidence of the effect of sugar on the body and the way children with ADHD really behave. It is based on my 65 years of ADHD and my reaction to sugar of any type whether it’s honey, high fructose corn sugar, refined sugar or brown sugar when I binge on sugar, it is the same results every time.  (see the previous post.)

First I would select 30 controls who ares clinically screened for ADHD and do not have any symptoms of ADD or ADHD. Next I would find 30 kids who definitely have ADHD and are being medicated for the disease. All would be in the same age group, probably 10 to 12 years olds because they are naturally the wildest. Finally, if possible, I would try for a third group of kids who are clinically screened as having symptoms but the diseases is either undiagnosed or untreated.

Now the design of the experiment would be double-blind with groups split in half. Neither the observers nor the children would know which group would get sugar candy or the non sugar candy. The observers would also not know which children had ADHD diagnosed or not and which group was normal.

The experiment would be run in an area set up as a playground with swings climbing stuff etc. Each child would be fitted with a heartbeat monitor, a wrist blood pressure monitor and a number on their back and front to quickly identify the children. It would be explained to the children that they are free to sample any of four to six candies and eat as much as they want and they would be asked about which ones were their favorites.  When the children were not sampling, they could play as much as they wanted or just eat more candy.  The would be free to drink soda (sugar or sugar-free depending on the group) or water as they saw fit. This would be also monitored for each child.

There are no rules or constraints.  Some of the observers should focus on the amount consumed by each child and others on the behavior of the children.  All should act normal as some are medicated into normalcy, some have undiagnosed symptoms because they are apparently normal and the rest are normal. About every 30 minutes, the children should be seated and their blood pressure and pulse rate checked. Then they should be directed to the candy table  where they are asked which ones they tried and what their favorites are and encouraged to recheck. After that, there are again no rules and the children are free to sample more candy or play. After a couple of hours, all candy would be removed and the children would be monitored for blood pressure and heart rate for three half hour intervals and have access to water only. 

About two weeks later, the same experiment would be run again with the groups reversed so all are tested for sugar sensitivity.

I am not sure whether the ADHD children would all be hyperactive, but I would guess that for those who binged, there would be phases of increased energy, and hyperactivity without problems, followed by a crash and either passive or cranky behavior. (Can I go yet? Huh? Huh?) I am also not sure whether the Parents of the ADHD sugar group would have enough trust in scientists to return their children for the second half of the experiment.

The other possibility is for my Granddaughters to skew the test. I have ADHD and her husband does too so the probability is both girls do and depending on circumstances, there symptoms can be severe.  Both are unmedicated, but my daughter is careful about their sugar consumption and what the eat.  They have both been programmed to avoid sugar and all carbonated beverages.  The oldest one is obsessive about following the rules and when together, the little one follows her lead.   If together for this experiment, both would play until every drop of energy has been expended and then they would get disgustingly cranky on a sugar low as they would hot have eaten or drank anything but water during the experimenta period.

Not all humans are the same and not all children with ADHD are the same.

Sugar, Me and ADHD; Part 2

June 13, 2012

Sugar is both my friend and enemy and like many other foods, sugar has many different forms and all effect me slightly differently depending on the form. On the positive side, one chocolate covered peanut M&M’s, regular M&M’s, Hershey’s Chocolate Bar, or one of anything in this type of candy can be a tremendous physical or mental stimulant for a quick energy rush.

I always take a couple of candy bars along on my most grueling hikes with tourists and I usually have a candy bar when the hardest part has been reached and the rest of the hike is easier. I get re-energized and always offer some to the others in the group. Usually, people who are slim and in shape decline. However, I am constantly amazed at the positive therapeutic effect it has on those who are a little overweight and out of shape. They too get re-energized and happily finish the walk. I think they are happy to have me, as a thin fit person, share their passion for candy.

At the other extreme are the sweet candies like hard butterscotch or sour balls and the soft jelly candy like orange slices, cherry slices, gummy bears, sour worms and skittles. These are extremely dangerous when they are sold in large bags at low prices, usually six to ten portions in a bag or somewheres around 900 to 1500 calories per bag. They are pretty much pure sugar with a little color and flavor added.  The other dangerous items are boxes of malt balls (700 calories) or Girl Scout Cookies about 1000 calories a box or more.

Now what causes my binge eating of candy?

There is only one answer and that’s availability. Candy bars are sold in 200 calorie units and I have programmed myself to buy just one so there is no problem. When it comes to the second group and without much forethought, I continue eating the sweets until they are all gone. It usually takes less than an hour.

Initially, there is a feeling of childlike euphoria where I am “happy as a kid eating candy.” This moves beyond euphoria to a real sugar rush, almost like an adrenaline flow, where my blood pressure and heart rate both go up. Eventually there is a return to normal where I get very drowsy and irritable and some might even say argumentative.  I am now down 90 pounds from my peak but old habits die hard. I have probably had five or six sugar binge episodes in the past year. I have learned to pretty much avoid them at home by not buying more than a candy bar for any reason. However, on two occasions, the price of gummy candy got so low that I just couldn’t resist the bargin and purchased big bags of gummy candy.

The rest of the time, I binged at my daughters house.  She really is trying to help but just doesn’t understand the word obsession. She will save all of the Halloween Candy and put it in a candy bowl on her counter for guests. Her family has been programmed to avoid eating candy and drinking any type of carbonated  beverage. Before I started the diet she scolded me at Thanksgiving  when she noticed I had not only eaten the candy bowl, but found her stash and eaten my favorites out of that and was working on the rest. I had compulsively eaten more candy in two days than her whole family had in three weeks. 

This started the Great Obesity Debates and the fact that I couldn’t go to Space Camp with my Granddaughters unless I dropped 40 pounds.  She thought my obsession with candy and food was more disgusting and obscene than the bottle of wine I drank every night. I have gotten better, well a little bit anyway, with a lot of  help from her.  Since no one in her house really likes or eats candy, she quietly discards it after Halloween right before I come.  The same is true of Easter.

My only temptation is when I search for and find her stash of Girl Scout Cookies, which she likes and it only takes an hour or two for me to eat the whole box. When she discovers the missing cookies, I put partial blame on her kids and Cousin Cait but she knows I’m lying.  I feel so ashamed, I normally only do one box per trip unless she doesn’t catch me. 

You can shed fat, you can’t shed obsessions. 

The Autism & ADHD Diet

June 10, 2012

I’m having a little trouble with the clustering of ADHD and Autism as a family of diseases to be treated in the same manner. My problem with this as a scientist is if you keep seeking erroneous solutions to a problem you will never solve it. Some recent work on DNA suggested that there might be overlapping genetic abnormalities that link the two diereses and it didn’t really seem plausible to me. I have a lifetime of experience with ADHD and have also closely observed Autistic children. I decided to check the original work and found one of the quickest jumps from conjecture to conclusion that I have seen in years.

In a study of 248 children with ADHD there were 22 (or 9%) with a specific type of abnormal gene that matched an abnormal gene in a few Autistic Children. With 91% of the group, there was no relationship at all.

The same study included 348 Autistic Children and there were only 9 with the same Gene. That means that 97% of the Autistic Children had no genetic overlap with ADHD. If there is a genetic link, scientists better keep on looking because the reality is exactly the opposite of the results.

In an auditorium of 600 children, about 60 will have severe ADHD and perhaps another 30 will have a milder form of ADHD or perhaps ADD which is definitely a part of ADHD. Of those 90 children with ADHD only one will be Autistic. There will be one other autistic child in the room. Now my problem is that there is a cult following of the Autism and ADHD Diets being used as part of a treatment program for both diseases and there are many books and websites devoted to the topic without much scientific study. If the Diet really works for the 89 kids who have ADHD alone, there is no reason to believe it will work for the two autistic children but they probably won’t or can’t complain.

If the diet doesn’t work for all 89 of the ADHD children, they probably won’t complain but learn to cope the same way ADHD people have been coping for generations. The easiest choice would be to eat more, get fat or obese by eating more of what they are served and then get a calming effect that goes with the food obsession. They may also seek cigarettes, sex, love, alcohol and marijuana to increase their dopamine so they can get the focus they need to survive in school.

In high school and college I did everything on that list and the only thing that saved me was organized sports. I loved the adulation from being good and the exercise also increases dopamine. I could also eat everything in sight and not get fat because of the high energy burn in sports. You could also take risks with your body and get a real adrenalin rush.

When my daughter, who is somewhat normal, asked about how to handle her ADHD kids, she knew she came to the real family expert. I told her they needed lots of love including hugs and verbal praise. They needed to be physically active to a point others might consider it excessive. As to foods, feed the brain. Fish and almost anything they like in the way of protein, whole grains, fresh or gently cooked vegetables and just observe adverse reactions and eliminate. Lots of fresh fruits and raw vegetables like in salads. The oldest is 12 and doing excellent in sports and school with only occasional symptoms that someone might question. The younger girl has not yet fallen into a pattern and still bounces off walls. Only God knows the future on her treatment but we are hoping that we all find the path without medication.

At my house, I have an artificial rock wall that leads to the roof and is exited by a fire pole. There is also a real cliff with a repelling rope and a 70 foot zip slide across a gully. There are plenty of ways to take risks and feed their adrenaline needs. In the morning, I also walk them for a swim and back after an hour or two in the sea. The walk down and back is three miles. Mid day is quiet time with structured school work and no one complains about the break. About 4 pm, I drive them back to the pool for a swim while I have my glass or two of wine. I do this for about 3 weeks each summer and have for the past four years. There is rarely a meltdown because the loss is too great. A meltdown means they need more rest so they lose all privileges and are sent to bed for a two-hour nap. If they scream, I request that they do it louder as it is music to an old mans ears. They will never know I can’t stand it. So keep my secret.

I know that this is close to the way I was raised and it worked for me and seems to be working for my granddaughters and Son-in -law. I don’t have any idea if this will work for anyone else but there is a certain element of science in raising their dopamine levels in a natural way so they avoid uncontrolled risks and stimulants.