Disease Proof

Some stashed away studies suggest many antidepressants aren’t all they’re cracked up to be. From the NewScientist:

It's called the "file-drawer problem". A study fails to produce interesting results, so is filed away and forgotten - a practice that might mean antidepressants don't work as well as doctors think.

To get approval for the 12 antidepressants that went on the market between 1987 and 2004, drug firms registered over 70 clinical trials with the US Food and Drug Administration (FDA). But when Erick Turner of Oregon Health and Science University in Portland and his colleagues combed through medical journals, they found that 23 of these studies never made it into a journal. All but one of the unpublished studies concluded that the effect of the drugs was negative or questionable.

“Soon almost all kids will be on medications for something,” said Dr. Fuhrman when I asked him to comment on a report suggesting bipolar disorder may be over-diagnosed in youths. Kind of foreboding, when you read this article by Melissa Healy of The Los Angeles Times, “Are we too quick to medicate children?” Here’s a bit:

In 2005, the latest year for which statistics are available, at least 2.2 million American children over the age of 4 were being treated for serious difficulties with emotion, concentration, behavior or ability to get along with others. It's a figure mental-health professionals say has exploded in the last decade and a half, along with sales of a wide range of psychiatric medications for use by children.

A welter of studies has shown that kids are being diagnosed at younger ages, with a wider range of disorders and with more severe disorders than ever before. And in growing numbers, they are being medicated with drugs whose safety, effectiveness and long-range effects on children have not been demonstrated by extensive research.

A study published in September found that the diagnosis among children of bipolar disorder, a mental illness long thought not to exist in kids, grew 40-fold over the last decade. The prescribing to kids of antipsychotic drugs typically used to treat the symptoms of bipolar illness have soared as well, despite continuing concerns over side effects such as weight gain, metabolic changes that can lead to diabetes, and tremors.

Psychiatrists admit they haven't drawn clear lines between problem behaviors and mental illness, especially in kids, and they are debating future fixes. But until those fixes are made, parents -- with their kids' futures on the line -- are left with little to guide them when a child is tagged with a psychiatric label.

Who am I to say when kids—or any person for that matter—should be given the assistance of psychotropic medications, but at the very least, before we start prescribing kids pills willy-nilly, shouldn’t safer options be tried first. Consider this excerpt from Dr. Fuhrman’s book Disease-Proof Your Child concerning children and ADHD. Take a look:

What has been shown to be highly effective in some recent studies is high-nutrient eating, removal of processed foods, and supplementation with omega-3 fatty acids.1 The difference between my approach and others is that it changes a poor diet into an excellent one, supplying an adequate amount of thousands of important nutrients that work synergistically as well as removing those noxious substances such as chemical additives, trans fat, saturated fats, and empty-calorie food that place a nutritional stress on our brain cells. I believe this comprehensive approach is more effective; the scientific literature suggests this, and I have observed this in my practice with hundreds of ADHD children who have see me as patients.

Eh, I guess its just easier to prescribe some pills and get back to shopping at the mall.

Reuters is reporting that two U.S. health agencies plan to study the effects of ADHD drugs on the heart. Take a look:

The U.S. Food and Drug Administration said it will collaborate with the Agency for Healthcare Research and Quality to examine clinical data of about 500,000 children and adults who have taken ADHD drugs, which include Novartis AG's Ritalin and Shire Plc's Adderall.

The analysis, expected to take about two years, will include all drugs currently marketed for treating ADHD. Millions of people take the medicines.

Because the drugs can increase heart rate and blood pressure, there are concerns they may raise the risk of heart attacks, strokes or other cardiovascular problems.

For more on ADHD, take a look at this post from the other day: Ritalin Stunts.

Get a load of this article Dr. Fuhrman emailed me. Apparently Ritalin—the drug doctors just love to prescribe for ADHD—might stunt growth. WebMD reported on it back in July, take a look:

The symptoms of childhood ADHD (attention deficit hyperactivity disorder) usually get dramatically better soon after kids start taking stimulant drugs. But this benefit may come with a cost, says James Swanson, Ph.D., director of the Child Development Center at the University of California, Irvine.

"Yes, there is a growth-suppression effect with stimulant ADHD medications," Swanson tells WebMD. "It is going to occur at the age of treatment, and over three years it will accumulate."

Whether these kids eventually grow to normal size remains a question. Kids entered the study in 1999 at ages 7 to 9. The current report is a snapshot taken three years later. The 10-year results — when the kids are at their adult height — won't be in for two more years.

"The big question now is whether there is any effect on these kids' ultimate height," Swanson says. "We don't know if by the time they are 18 they will regain the height."

For more on ADHD, check out DiseaseProof’s ADHD category.

Maybe the Pink Floyd song should go, “Hey doctors…we don’t need your medication.” Denise Gellene of The Los Angeles Times reports bipolar disorder may be over-diagnosed in youths:

The report in the journal Archives of General Psychiatry said bipolar disorder was found in 1,003 of every 100,000 office visits from children and adolescents in 2002-03, compared with 25 of 100,000 office visits in 1994-95.

The diagnosis of bipolar disorder among adults increased twofold during the same period, researchers said.

The study didn't investigate the reasons for the sudden rise in bipolar cases among children and adolescents. A book published in 2000, "The Bipolar Child," made the controversial assertion that one-third to one-half of children with depression had bipolar disorder.

Dr. Mark Olfson, a psychiatrist at Columbia University's College of Physicians and Surgeons and senior author of the latest study, said part of the increase was attributable to an under-diagnosis of bipolar disorder in the past.

But Olfson said another reason was the mislabeling of children and adolescents with aggressive or irritable behaviors as bipolar, an illness that is treated with powerful psychotropic medications, many of which have not been tested in children.

I’ve got plenty of little cousins and I can I tell you firsthand. At least half of them are hopped up, a scary reality and perhaps, all too common. Here’s what Dr. Fuhrman had to say about this:

I don’t know, but I am always suspicious of all these diseases that are increasing in the last 20 to 30 years with our chemicalized, drugged, medicated, polluted, and nutrition-less toxic food environment. Soon almost all kids will be on medications for something.

For more on this sort of issue, check out these posts:

• ADHD Drugs for Obese Kids
• Dr. Fuhrman Discusses DHA for Children
• ADHD Over-Diagnosis and Treatment Options

Got noisy neighbors? Do they keep you awake at night with their incisive banjo playing? Here’s an idea, try taking a drug that lists hearing loss as a potential side effect, that’ll fix your problem in a jiff. Sounds pretty ridiculous, right? Not to one doctor, who prescribed an ADHD drug to a teenage patient who couldn’t lose weight. Why? Because the ADHD drug Adderall comes with a risk of weight loss—the teenager didn't even have ADHD! Elizabeth Cohen of CNN reports:

Their pediatrician didn't know either, so she referred Lisa and Hank Veith to Dr. Fuad Ziai, a pediatric endocrinologist in nearby Oak Lawn, Illinois. In the summer before Alex entered sixth grade, Ziai prescribed Adderall, an amphetamine used to treat attention deficit and hyperactivity disorder, or ADHD. Alex didn't have ADHD, but one of the drug's common side effects is weight loss. And that's what happened to Alex.

"You should have seen everyone when I went back to school the next year. They didn't believe it was me," says Alex. "It was a great feeling to be a thin kid."

Ziai's approach to treating obesity -- he says he has prescribed Adderall for weight loss to about 800 children and teens -- raises an important ethical question: Has the obesity epidemic among children become so severe that it's OK to prescribe a drug not approved for weight loss when the drug can have serious, sometimes life-threatening side effects?

The Veiths say they'd give their son Adderall again. Now 17, Alex is a normal weight after being on the drug for more than four years -- from age 11 until about 18 months ago.

Now I’m no doctor, but treating patients with side effects seems crazy to me, especially when you consider all the issues surrounding the diagnosis of ADHD and the usage of ADHD drugs. Dr. Fuhrman discusses this in a previous post. From ADHD Over-Diagnosis and Treatment Options:

These medications with their reported adverse effects and potential dangers were simply unnecessary for so many children whom I have seen as patients. I have witnessed consistently positive results when these children followed my comprehensive program of nutritional excellence. The scientific studies lending support to a comprehensive nutritional approach to treating ADHD are ignored by physicians, and drugs are generally the only method offered.

Most new cases of ADHD are of the inattentive subtype. Inattentive ADHD are the children who have a short attention span, are easily distracted, and can appear to be a brain fog; they do not have hyperactivity. Research on the use of psychostimulants in these patients has shown high rate of nonresponders, and although medications showed a short-term decrease in symptoms, they did not improve grade point averages.2

Here’s a couple more posts on the topic:

• Dr. Fuhrman's Anti-ADHD Plan
• Children, ADHD, and Nutrition

If you haven’t noticed, we do a lot blogging—don’t blink! You might miss something. In case you did, here are some highlights from the past couple of months:

• Do you remember Canto and Owen? You don’t? What if I said healthy monkey, grumpy monkey? Still no? Okay I’ll remind you. They're the two monkeys helping scientists determine the benefits of a calorie restrictive diet. It appeared in The New York Times about a week ago:

The New York Times introduces us to Canto and Owen, two rhesus monkeys on totally different sides of the calorie restriction spectrum. Canto who eats 445 calories a day is healthier and much younger looking than his buddy Owen who consumes 885 calories daily—Owen doesn’t appear happy about it. Some scientists believe the plight of Canto and Owen sheds serious light on the benefits of calorie restriction for humans.

• Here’s another one from The New York Times. I was very alarmed to read that more and more children are going through puberty earlier and earlier. Puberty in preschool is pretty hard to believe, but according to Dr. Fuhrman a vegetable-based diet can help buck this trend:

Fat cells produce estrogen, so excess fat on the body during childhood results in more estrogen production. A large volume of high fiber from fruits and vegetables in the gut serves to lower circulating estrogen naturally. The high fiber and the resultant healthy bacteria that colonize the gut of a person consuming a high produce diet conjugates (binds together) estrogens so they are more readily excreted in the stool. As estrogen cycles into and out of the digestive tract, a person eating more animal products and less high-fiber vegetation reabsorbs more estrogen from the digestive tract, rather than losing more in the stool.

• Sometimes you’ve just got to stick with what you’re good at—someone should pass on this bit of knowledge to Chicago Bears wide-receiver Bernard Berrian. Last month he talked to school children about the benefits of eating bacon and maple syrup. No, I’m not joking:

What ensued was a melee of animal fat drizzled in hearty helpings of liquid sugar. Correct me if I’m wrong, but aren’t these the types of things school food reforms are trying to knock out? It gets worse, here’s my favorite—well not-so-favorite—quote from Bernard:

It’s the perfect combination, you should eat it everyday and you’ll be in the NFL too.

• This next post really got the low-carb loonies in a twist. According to The Washington Post many adults still embrace childish reasons why they won’t eat their veggies. In fact, one low-carber even had some pretty cockamamie thoughts on the importance of vegetables:

Who the hell cares about the veggies anyway? You don't need them and there is absolutely nothing essential about them. Don't let the acculturated veggie sympathizers tell you otherwise.

• After a hard fought day of soccer what would you reach for, water, orange slices, how about some chips and Ho Ho’s? In this New York Times Op-Ed piece author Harlan Coben rails against soccer moms and dads who serve up junk-food after the big game:

Are none of us reading about the obesity of our young people? Do you think it helps their well-being that after every sporting event our children gorge themselves Fall-of-Roman-Empire style on extra calories, extra sugar, extra hydrogenated fat? I recently sat down with Annette O’Neill, a registered dietitian and bona fide nutritionist, and asked her, “Do you think it’s a good idea for our kids to have Cheetos and Kool-Aid after a sporting event?” Her response: “Uh, no.”

• I admit I don’t blog about Attention Deficit Hyperactivity Disorder (ADHD) very often, but in this post fellow doctor blogger Dr. Flea discusses the over-diagnosis of ADHD:

In Disease-Proof Your Child Dr. Fuhrman says, “The diagnosis and treatment of Attention Deficit Hyperactivity Disorder has skyrocketed in recent years, with a tremendous increase in the percentage of our elementary school children who are taking amphetamines and stimulants such as Ritalin, Adderall, Concerta, Cylert, and others.” So as a layman, I wonder—what's going on here? Is this some kind of epidemic?

• This might be the most alarming news item I’ve read over the past few months. Back in October the FDA rejected a petition to further limit the use of mercury in vaccines—pretty unnerving. Dr. Fuhrman is equally concerned because mercury is one bad mama-jama:

The injection of even this small amount of mercury repeatedly year after year from multiple vaccines can cause neurotoxicity (brain damage). The American Academy of Pediatrics and the US Public Health Service have issued a joint statement calling for the removal of mercury from vaccines. Chronic low dose mercury exposures may cause subtle neurological abnormalities that rear their head later in life.

When I was a kid, as far as I was aware, not one of my classmates had Attention Deficit Hyperactivity Disorder (ADHD). In fact, it wasn’t until high school that I realized lots of grade school children had this condition. Now, many years later, it seems ADHD is everywhere.

In Disease-Proof Your Child Dr. Fuhrman says, “The diagnosis and treatment of Attention Deficit Hyperactivity Disorder has skyrocketed in recent years, with a tremendous increase in the percentage of our elementary school children who are taking amphetamines and stimulants such as Ritalin, Adderall, Concerta, Cylert, and others.” So as a layman, I wonder—what's going on here? Is this some kind of epidemic?

Dr. Flea, a doctor-blogger offers some evidence for the over-diagnosis of ADHD. He references an article in The Scientific Review of Mental Health Practice (SRMHP):

ADHD is diagnosed and treated differently in communities across the United States, as evidenced by the 30-fold variation in per capita rates of Ritalin use. The probability that ADHD is diagnosed appropriately in some communities should not serve to dismiss concerns about overdiagnosis in all communities. Rates of treatment are consistently highest among younger (i.e., under age 10), nonminority, and male school-age children. The evidence of ADHD overdiagnosis is obscured when findings are reported without respect to geographic location, race, gender, and age. The fact that ADHD is clearly overdiagnosed in some communities and among some groups of children (e.g., one in every three white elementary-aged boys in southeastern Virginia) is lost in nationwide estimates of ADHD drug treatment. It is essential that mechanisms be established to track rates of child mental health diagnoses and psychotropic drug treatment and its outcomes among American children. Until we have a better understanding of these issues, it is appropriate to be judicious in our use of psychotropic medications and cautious about dismissal of concern about ADHD overdiagnosis.

In Disease-Proof Your Child Dr. Fuhrman explains that, “As many as 9 percent of school-age children show symptoms of ADHD such as inattention, hyperactivity, impulsivity, academic underachievement, or behavioral problems.”1 He goes on further to explain that stimulants and amphetamines are unnecessary for treating these children, and that nutritional excellence is a better option:

These medications with their reported adverse effects and potential dangers were simply unnecessary for so many children whom I have seen as patients. I have witnessed consistently positive results when these children followed my comprehensive program of nutritional excellence. The scientific studies lending support to a comprehensive nutritional approach to treating ADHD are ignored by physicians, and drugs are generally the only method offered.

Most new cases of ADHD are of the inattentive subtype. Inattentive ADHD are the children who have a short attention span, are easily distracted, and can appear to be a brain fog; they do not have hyperactivity. Research on the use of psychostimulants in these patients has shown high rate of nonresponders, and although medications showed a short-term decrease in symptoms, they did not improve grade point averages.2

Before a parent begins to consider the pros and cons of starting their inattentive child on stimulants such as Ritalin, they should give nutritional excellence a trial. Nobody knows for sure the long-term dangers of these stimulant drugs or if taking them for a long period of time during childhood increases one’s later life risk of cancer. There certainly is some risk, especially because they can cause cancerous tumors in mice.3

What has been shown to be highly effective in some recent studies is high-nutrient eating, removal of processed foods, and supplementation with omega-3 fatty acids.4 The difference between my approach and others is that it changes a poor diet into an excellent one, supplying an adequate amount of thousands of important nutrients that work synergistically as well as removing those noxious substances such as chemical additives, trans fat, saturated fats, and empty-calorie food that place a nutritional stress on our brain cells. I believe this comprehensive approach is more effective; the scientific literature suggests this, and I have observed this in my practice with hundreds of ADHD children who have see me as patients.

Check out this previous post for George Grant’s success story: Children, ADHD, and Nutrition

From Dr. Fuhrman's book Disease-Proof Your Child:

Nutritional excellence combined with classroom and behavioral modification for rewarding positive behavior is a promising approach for treating ADHD. Often family therapy is necessary as well to address behavioral, emotional, and self-esteem issues. Combined with a vegetable-based, high nutrient diet, great results are the norm, not the exception. The essential features of my dietary approach for ADHD are as follows:

• A high-nutrient, vegetable-nut-fruit-based diet
• One tablespoon of ground flax seeds daily, easily added to oatmeal, shakes, and desserts
• At least one ounce of raw walnuts daily, with the addition of other raw nuts
• DHA supplement of 100-600 mg daily
• No processed foods, no dairy fat, no trans fat
• Little or no oils; essential fats are supplied from raw nuts and seeds and DHA supplementation
• Some children also must avoid gluten (from wheat products) and/or casein (from dairy products), as they appear to be bothered by these frequently difficult-to-handle dietary proteins

Until recently, the primary source of DHA dietary supplements was fish oil. However, new products are available that contain DHA from algae, the fish’s original source. Unlike fish oils, the algae-derived DHA, grown in the laboratory, is free of chemical pollutants and toxins that may be present in some fish oil-based brands. I recommended favorable DHA products that are designed for purity and are suitable for children. Neuromins is a common (non-fish-derived) brand of DHA sold in most health food stores, and I also have designed and manufactured an all-plant-derived DHA supplement, available on my DrFuhrman.com and in my office.

To feed DHA-rich oil to a child is not difficult; just slice open the capsule with a serrated knife and mash it into a banana or mix it in orange juice or in morning oatmeal to disguise the taste. The dose may vary from 100 to 600 mg daily depending on the age and condition of the child. A child over the age of six with ADHD can be started on the higher dose for the first six months, and then the dose can be decreased to 400 mg daily for the next six months. I generally recommend supplementation with 100 mg a day for seven and older. However, this dose should be doubled for those with ADHD until the symptoms resolve.

Many families who have adopted my diet of nutritional excellence, combined with judicious use of nutritional supplements, report that they begin to see improvement in as little as three months. Keep in mind, this nutritional approach to ADHD does not magically make the problem disappear overnight; it could take six months to observe a significant change in behavior. The chief factor that indicates a successful outcome is the entire family’s willingness and desire to adopt a new healthy eating style for the benefit of all members. The child with the ADHD problem is never singled out as the only one required to eat healthy. In fact, I encourage the children to take responsibility in helping the parents to eat healthy, too. This prescription calls for nutritional excellence for the entire family. When families choose to work as a unit to improve the child’s emotional environment and nutrition simultaneously, it is rare that psychostimulant medications are necessary.

You can listen online as Dr. Fuhrman discusses recent news about the FDA investigating deaths that may have been related to ADHD drugs. He will be a guest a little after 8pm ET (5pm Pacific) on Thursday, February 9--in about two hours from this writing.

Click here for more of Dr. Fuhrman's thoughts and anecdotes about treating ADHD with diet.

UPDATE: Gardiner Harris of The New York Times explains the new concerns about the effect some prescription stimulants may have on heart disease.

The votes came after F.D.A. medical officers described reports of 25 sudden deaths among people taking stimulants — the deaths were mostly children — and a preliminary analysis of millions of health records that suggested stimulants might increase the risks of strokes and serious arrhythmias in children and adults. The reports of sudden deaths never exceeded one in a million for any stimulant drug, although the F.D.A. usually receives reports of only a fraction of drug problems.

The preliminary analysis suggested that the stimulants might increase heart risks more than twofold. Such an increase may not be significant in children, whose heart risks are low, but could cause concern in adults, panel members said.

One of the drugs, Ritalin, has been marketed since 1955, and dozens of studies have shown it to be safe and effective. But no studies have been of sufficient duration or included enough participants to evaluate stimulants' long-term effects on the heart.

But the drugs' soaring popularity and increasing use in adults, panel members said, mean that the F.D.A. should study them more closely and warn patients and doctors about the potential risks to the heart.

Arthur A. Levin, director of the Center for Medical Consumers in New York City and a member of the panel, said that patients assumed that stimulants were safe, but that that confidence was misplaced.

"For us to sit around and talk about it, and for us to not make a very strong warning about the uncertainty of these drugs and their possible risks, would be unethical," Mr. Levin said.

Docosahexaenoic acid (DHA) is a long-chain omega-3 fatty acid. About half of the brain and eyes are made up of fat, much of which is DHA, which is an essential nutrient for optimal brain and eye function.1 Children's diets today are notoriously low in the beneficial omega-3 fats found in foods such as walnuts, flax seeds, soybeans, leafy greens, and certain fish. I do not recommend fish as a preferred source of these beneficial fats for children because of contamination with pollutants and mercury.

The most commonly used supplement to add DHA to the diet is fish oils, but what is not widely known is that most of us can produce sufficient DHA from short-chain omega-3 fatty acids received from walnuts, flax seeds, and green vegetables. Many fish make their DHA from eating greens, too, from algae.

New products are available that contain DHA from algae, the fish's original source. Unlike fish oil, the algae-derived DHA, grown in the laboratory, is free of chemical pollutants and toxins that may be present in some fish oil-based brands. I recommend favorable DHA products that are designed for purity and are suitable for children. Neuromins is a common (non-fish-derived) brand of DHA sold in most health food stores, and I also have designed and manufactured an all-plant-derived DHA supplement, DHA Purity, available on my Web site and in my office.

DHA is also a normal component of breast milk, and infants fed breast milk score higher on intellectual and visual measurements than those fed baby formulas lacking DHA. Children who were breast-fed, as a group, have higher IQ scores than those who were formula fed.2 Pregnant women should pay close attention to their DHA status to ensure proper DHA supply for prenatal development. Maternal supplementation with DHA during pregnancy, and lactation has been demonstrated to augment children's IQ.3

DHA is present in breast milk, but up until 2002, the United States was the only country in the world where infant formulas were not fortified with DHA, despite a 1995 recommendation by the World Health Organization to do so. In addition, the average DHA content of breast milk in the United States has been tested to be low compared to other countries that consume more fish. In fact, postpartum depression, lower IQ, dyslexia, and Attention Deficit Hyperactivity Disorder (ADHD) have been linked by many scientific studies to the low DHA intake common in the United States.4

Deficiency in DHA fatty acids has been linked to:

• Impulsiveness
• Aggressiveness
• Dyslexia
• Depression
• Reduced intelligence
• Sleep problems
• Temper tantrums
• Alcoholism
• Schizophrenia
• Manic depression 5

The first year of life is a crucial year that sets the stage for your child's healthy body and mind. Exposure to DHA-rich breast milk while the brain is rapidly growing assures that your child will develop his full intelligence potential. To supplement her healthy diet, Mom should be taking a multivitamin plus a daily DHA supplement containing approximately 200 mg of DHA, to assure adequate DHA content in her breast milk. Even after food is introduced, continued breast-feeding is important and necessary past the first birthday for maximum disease resistance, immune function, and brain development.

Once your child is off breast milk, I recommend that parents add a small amount of DHA (50 to 100mg) to their child's orange juice, oatmeal, or other food. Even if you don't do it every day, it still ensures that no child will suffer the consequences of DHA deficiency during these crucial years of brain development. When our children don't consume the right mix of brain boosting nutrients, they have a reduced ability to learn and a lower IQ, and later in life they can develop dementia and Alzheimer's disease. On the other hand, the right mixture of brain-supporting foods will afford our children the ability to reach their maximum potential in life, not just for health, but for emotional stability, happiness, and success in their chosen careers.

The diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD) has skyrocketed in recent years, with a tremendous increase in the percentage of our elementary school children who are taking amphetamines and stimulants such as Ritalin, Adderall, Concerta, Cyclert, and others. These medications, with their reported adverse effects and potential dangers, were simply unnecessary for so many children whom I have seen as patients. I have witnessed consistently positive results when these children followed a comprehensive program of nutritional excellence.

One such success story involves George Grant, age eleven, the nicest and most polite boy you would ever meet. Although his parents reported an improvement in his concentration and behavior since beginning Ritalin two years prior to his appointment with me, they were unsatisfied. George had frequent headaches and stomachaches from the medication, and he had tried the other stimulant medications and found that the same problems occurred.

I enjoyed meeting George and talking to him; he was surprisingly mature and interested in his school performance, and did not want his grades to suffer. I told them that it would take about three to six months to really evaluate whether nutritional intervention would work as effectively as the Ritalin, but there was one thing I could promise them: George would feel better, sleep better, have a better appetite, and his headaches and stomachaches would go away within a few weeks with high-nutrient eating.