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Articles by Dr. Billy Levin
Diet factor in ADHD
Attentional Deficit Hyperactivity Disorder is an inherited neurological condition that presents as either a learning problem or a behaviour problem or both in varying degrees from mild to very severe. It is found more in boys than in girls, is often overlooked especially in girls who present with fewer behaviour problems. If undiagnosed it can, for some, have major repercussion in later life. It is unrelated to I.Q. or social status.
Dr W.J.Levin, July 2004
Medical science has clearly established criteria for diagnosis and treatment and there is very little controversy among experts internationally. However because most experts suggest that stimulant medication, like Ritalin and Ritaphen be prescribed, to make the child more teachable, many non experts feel too much medication is being prescribed. Some go even further and suggest the medication is harmful or even habit forming. The media overplay this scenario with journalistic sensationalism with little regard for the truth or the harm caused by misinformation. This situation has reached such proportions that it prompted eighty one fully fledged university appointed professors from all over the world to sign a petition objecting to this misinformation frightening patients away from correct medical treatment which is absolutely safe and very effective if correctly used.
There is more misinformation about the cause and the treatment of ADHD than any other medical condition known to man. One wonders why this is so. On the other hand, if this is true, it can only lead to confusion, consternation and to the detriment of the people who really need help. Yet there are very loud voices claiming their point of view even without proof or substantiated research. Does vested interest and profit play a role? I am sure it does. This makes factual information all the more important for the misinformed. Gullible parents, afraid of medical treatment turn very readily to any other form of treatment irrespective of whether it works or not.
Many years ago an American allergist named Ben Feingold claimed he had researched that diet played a role in causing ADHD and developed the "Feingold Additive Free " diet which became very popular, especially as it offered an alternative to the stimulant medication like Ritalin. Professor Renshaw of Loyola University, Chicago, challenged him to publish his research and findings in a medical journal, and allow a peer review of his work. He never did. All his publications were in "glossy" layman's magazines. Yet research done at various University clinics to duplicate his research and conclusions could not be shown to have any value. If this diet was followed very strictly malnutrition could result.
A very underhand research project, but nevertheless very significant, requested parents whose children who were on an exclusion diet for ADHD to submit these children for research. Unknown to the parents, the children were given capsules containing the very substances the parents were excluding in the child's diet. No parent noticed any change or worsening of their child's behaviour. The parents thought diet played a role. Science showed it did not!
A nutritional /vitamin supplement marked in South Africa for ADHD was researched by a Homeopathic student for his Masters degree at the Techincon, Johannesburg. He suggested it helped for concentration but could not be shown to help hyperactivity. The psychologist, who supervised this dissertation, in a personal discussion with me, could not see any statistical evidence to suggest it had any value. In my own practice 50 consecutive referrals to me for ADHD, who were on this product, did not respond what so ever. The parents stated categorically it did not work and the treatment was stopped. They all responded very well to monitored titrated stimulant medication. The feed back was from the parents, teachers and child.
A product was advertised in the "Sunday Times" paper for hyperactivity.
I e-mailed their website for proof and research. They replied that research in Nicaragua in 1990 was done. The only research in this fourth world country was done by Americans about the poor nutritional status of many of their children. No research was published on ADHD according to the research journal from the American Psychological society.
In a 'glossy' South African magazine an advert appeared for a herbal product for ADHD and in particular it was stated that Ritalin a habit forming Amphetamine drug should not be used. The Advertising Standards Bureau are investigating this situation at the moment. Ritalin is not habit forming, is not an amphetamine and is not a dangerous drug.
In the South African "Medical Chronical" journal some time ago an article, by Dr Steven Parker from Boston University School of Medicine, suggested the diet factor for hyperactive kids was "mostly hooey".
Double blind controlled studies from pooled data showed less than 1% improved on the diet, yet parents in non-controlled studies thought 40% improved. The power of suggestion?
An internet program, , dedicated to flush out non-scientific medical treatments and sponsored by donations only and no vested interests, have suggested the diet has no value and has not been shown in any research to be of any real value.
Professor Steven Cope from the University of Georgia, U.S.A., visited South Africa recently lecturing on ADHD. When I asked him personally why he has never spoken about the diet factor and ADHD in his lectures, his reply was very simple and to the point. He stated his mandate was to talk on ADHD and not about nonsense!
A review article in the New England of Medicine by Zametkin and Ernst suggested "given the minimal evidence of efficacy and extreme difficulty of children to comply with restricted diets, they should not be recommended" for ADHD patients.
One must recognise and accept that many an ADHD child has developmental lags and inabilities only in some areas of the brain and not in all areas. They also often have talent in other areas. They are not "pervasive developmental delays" and are not retarded. Most of the immaturities are to be found on the left hemisphere of the brain causing learning problems, and the excessive talent areas on the right brain causing a behaviour problem. There is no way that a diet can foster right brain and hamper the left. There are a very high percentage of ADHD children with mixed laterality or left handedness. Surely a diet cannot cause this. Moreover in a family of four children, for example, all subjected to the same diet, only one may have ADHD. Why did the same diet not affect the others.
Far more boys have ADHD than girls. How can a diet affect one sex more than the other. Only the sex hormones can do this. It is interesting to note that the male hormone, Testosterone boosts the right brain and Estrogens, the female hormone the left-brain. If right brain dominance results in hyperactivity, a very good reason why more boys than girls are affected from a behaviour point of view. Loss of estrogens with reduced left brain efficiency results in a learning problem. Girls have more learning problems than boys.
There are certain external superficial features found more often in ADHD patients than in the rest of the population. These mesomorphic features include a high palate, wide nasal bridge, an epicanthic fold on the side of the nose, double crown in the hair, blond electric hair, asymmetrical face, curved little finger, simian fold in the palm of the hand, webbed toe between second and third toe and a very wide space between first and second toe. These features are present at birth, and can not be caused by a faulty diet ever!
As ADHD is very often a genetic condition, one of the parents or both may have had or still have ADHD severe enough to be recognisable and even needing treatment. The parents diet could be very different from the child's one. The current diet could never have caused the parent's problem when they were young.
It has been shown that certain colourants, especially yellow (Tartrazine) and red (Erythrocin B) may irritate certain sensitive children. These are very young children prior to nursery school age. In most, as they grow the effect of the colourants becomes less noticeable and eventually of no importance what so ever. Thus it must be accepted that the colourants are not a causative factor but rather a contributing factor to ADHD.
With this information in mind it should allow a parent to debate very seriously about the values of so many "over the counter" products of no proven value. These are suggested by layman, with no scientific knowledge and sold to ADHD patients, for financial gain with no regard for the outcome. The many suggested diets which also have no proven value, must be seen in the same light. This is especially important when one considers that given to the right person for the right reasons, medication is safe and effective if used correctly.
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