ADD and Naturopathic Medicine ©Dr. Kevin Passero 2004 Dr. Kevin Passero, N.D 203 Ridgely Ave Annapolis, Md

Naturopathic Medicine What is it? Naturopathic Medicine blends centuries-old natural, non-toxic therapies with current advances in the study of health and human systems. Naturopathic Medicine blends centuries-old natural, non-toxic therapies with current advances in the study of health and human systems.

The Six Principles 1) The Healing Power of Nature. Naturopathic Doctors believe that the natural state of the body is to be healthy. Our jobs are to help the patient identify and remove obstacles to healing and allow the body to heal itself. 1) The Healing Power of Nature. Naturopathic Doctors believe that the natural state of the body is to be healthy. Our jobs are to help the patient identify and remove obstacles to healing and allow the body to heal itself.

The Six Principles 2) Identify and Treat the Causes. The Naturopath seeks to identify and remove underlying causes of illness, rather than to merely eliminate or suppress symptoms. 2) Identify and Treat the Causes. The Naturopath seeks to identify and remove underlying causes of illness, rather than to merely eliminate or suppress symptoms.

Symptoms as messengers Naturopathic Medicine attempts to find the underlying cause of the patient’s condition. Naturopathic Medicine attempts to find the underlying cause of the patient’s condition. Much of modern medicine, conventional and alternative is focused on symptom management. Often this means neglecting the possibility of an underlying cause. Much of modern medicine, conventional and alternative is focused on symptom management. Often this means neglecting the possibility of an underlying cause. Symptoms are messengers, and what happens when we shoot the messenger? We don’t know from where the message came. Symptoms are messengers, and what happens when we shoot the messenger? We don’t know from where the message came.

The Six Principles 3) First Do No Harm. 3) First Do No Harm. The Naturopathic Doctor implements this third rule with the following precepts The Naturopathic Doctor implements this third rule with the following precepts Utilize methods and medical substances which minimize the risk of harmful side effects. Utilize methods and medical substances which minimize the risk of harmful side effects. Avoid when possible the harmful suppression of symptoms. Avoid when possible the harmful suppression of symptoms. Acknowledge, respect and work with the individual’s self-healing process. Acknowledge, respect and work with the individual’s self-healing process.

The Six Principles 4) Doctor As Teacher. 4) Doctor As Teacher. As Doctor’s we not only believe it is our job to help people improve their health, it is also our job to educate them so they can be responsible for their own health as well. As Doctor’s we not only believe it is our job to help people improve their health, it is also our job to educate them so they can be responsible for their own health as well. Encouraging self-responsibility for one’s health is a major goal for the Naturopathic Doctor. Encouraging self-responsibility for one’s health is a major goal for the Naturopathic Doctor.

The Six Principles 5) Treat the Whole Person 5) Treat the Whole Person This is achieved by taking into account individual physical, mental, emotional, genetic, environmental, social and spiritual factors. This is achieved by taking into account individual physical, mental, emotional, genetic, environmental, social and spiritual factors.

The Six Principles 6) Prevention 6) Prevention Prevention involves assessing individual risk factors, heredity and susceptibility to disease and making appropriate interventions in partnership with the patients to prevent illness. Prevention involves assessing individual risk factors, heredity and susceptibility to disease and making appropriate interventions in partnership with the patients to prevent illness.

How are ND’s trained? Naturopathic Medical colleges are four-year, graduate level medical schools with admission requirements comparable to those of other medical schools. The Doctor of Naturopathic Medicine degree (ND) is awarded after classroom, clinic and practical study. Naturopathic Medical colleges are four-year, graduate level medical schools with admission requirements comparable to those of other medical schools. The Doctor of Naturopathic Medicine degree (ND) is awarded after classroom, clinic and practical study.

ND’s are trained in medical sciences including Anatomy Anatomy Neurology Neurology Pathology Pathology Obstetrics Obstetrics Pharmacology Pharmacology Lab diagnosis Lab diagnosis Cardiology Cardiology Biochemistry Biochemistry Minor surgery Minor surgery Immunology Pediatrics Clinical and physical diagnosis Physiology Radiology Microbiology Gynecology Dermatology

What NDs do Clinical Nutrition Clinical Nutrition This refers to both the practice of using food to heal people and using food to maintain optimal health. This refers to both the practice of using food to heal people and using food to maintain optimal health. Nutritional supplements are often employed to further help people optimize nutritional intake for their particular needs. Nutritional supplements are often employed to further help people optimize nutritional intake for their particular needs.

What NDs Do Homeopathy Homeopathy Homeopathy is a form of medicine that uses extremely diluted preparations of substances to cure illness. Homeopathy is a form of medicine that uses extremely diluted preparations of substances to cure illness. As a medicine, it is unparalleled in its ability to effect people on a physical, mental and emotional level while at the same time having virtually no side effects or drug interactions. As a medicine, it is unparalleled in its ability to effect people on a physical, mental and emotional level while at the same time having virtually no side effects or drug interactions.

What NDs Do Botanical Medicine Botanical Medicine Plant substances are safe and powerful tools in the treatment of many illnesses. Plant substances are safe and powerful tools in the treatment of many illnesses. Most modern pharmaceuticals are originally derived from plant compounds. Most modern pharmaceuticals are originally derived from plant compounds.

The Egg of Health

ADD/ADHD And Naturopathic Philosophy

ADD/ADHD- What is it? ADD/ADHD is classified by the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition as a mental disorder primarily characterized by a “persistent pattern of inattention and/or hyperactivity – impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development.” ADD/ADHD is classified by the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition as a mental disorder primarily characterized by a “persistent pattern of inattention and/or hyperactivity – impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development.” ADD/ADHD can be considered as a broad collection of processing errors and disorders in the nervous system. ADD/ADHD can be considered as a broad collection of processing errors and disorders in the nervous system. The part of the brain controlling focus and concentration is slowed down or dysfunctional. The part of the brain controlling focus and concentration is slowed down or dysfunctional.

ADD/ADHD 1 in 5 U.S. boys takes a controlled stimulant medication for the management of ADD/ADHD symptoms 1 in 5 U.S. boys takes a controlled stimulant medication for the management of ADD/ADHD symptoms Between 9 and 12 million children currently are diagnosed with ADD or ADHD Between 9 and 12 million children currently are diagnosed with ADD or ADHD Over 350 million doses of Ritalin are distributed each day in the United States Over 350 million doses of Ritalin are distributed each day in the United States

Why Boys? It is speculated that boys are more susceptible to conditions like ADD/ADHD and Autism because of the interaction between testosterone and mercury It is speculated that boys are more susceptible to conditions like ADD/ADHD and Autism because of the interaction between testosterone and mercury

Why Boys? The main routes of exposure to mercury are via thimerisol containing vaccines and mercury found in food. The main routes of exposure to mercury are via thimerisol containing vaccines and mercury found in food. The CDC recently released data showing a 2.4% increase in the risk of Autism if you have received thimerisol containing vaccines. The CDC recently released data showing a 2.4% increase in the risk of Autism if you have received thimerisol containing vaccines. The government considers anything that results in a 2% increase in the chance of getting a condition to be causal. The government considers anything that results in a 2% increase in the chance of getting a condition to be causal.

Central Issues in ADD/ADHD The Adrenal Glands and Cortisol Regulation The Adrenal Glands and Cortisol Regulation Blood Sugar Regulation Blood Sugar Regulation Gastrointestinal Health and Function Gastrointestinal Health and Function Proper Elimination and Detoxification Proper Elimination and Detoxification

The Adrenal Glands and Cortisol

Cortisol, What is it? A steroid hormone released from the adrenal glands to increase energy in response to stress. A steroid hormone released from the adrenal glands to increase energy in response to stress. Under times of stress the body needs more energy. Cortisol is released in an effort to provide this energy. Under times of stress the body needs more energy. Cortisol is released in an effort to provide this energy. The energy derived from cortisol is a result of its ability to stimulate the body to release glucose into the blood. The energy derived from cortisol is a result of its ability to stimulate the body to release glucose into the blood.

Cortisol and Daily Rhythms

What does Stress Mean A stress related rise in cortisol can be triggered by physical stress (strenuous exercise, surgeries and physical trauma), mental stress (school, work, money), and emotional stress (relationships, family etc.) A stress related rise in cortisol can be triggered by physical stress (strenuous exercise, surgeries and physical trauma), mental stress (school, work, money), and emotional stress (relationships, family etc.) Large fluctuations in blood sugar also elicit a cortisol response Large fluctuations in blood sugar also elicit a cortisol response

Cortisol and ADD Is it high or is it low? Is it high or is it low?

Cortisol and ADD Many children with ADD already have a significant physiologic stress that predisposes them to the condition. Coupled with daily stress of family life and school these kids are usually in a state of cortisol imbalance. Many children with ADD already have a significant physiologic stress that predisposes them to the condition. Coupled with daily stress of family life and school these kids are usually in a state of cortisol imbalance. Overall Adrenal function is not optimal due to overexertion. The situation can be likened to burning a candle at both ends. Overall Adrenal function is not optimal due to overexertion. The situation can be likened to burning a candle at both ends.

The Adrenal Gland

The Adrenal Connection Cortisol is essential for normal functioning of human physiology. Without proper cortisol regulation energy levels, sleep cycles, immune function and mental capabilities will all be compromised. Cortisol is essential for normal functioning of human physiology. Without proper cortisol regulation energy levels, sleep cycles, immune function and mental capabilities will all be compromised. Secondly, as chronic stress persists the portion of the adrenal gland responsible for cortisol production can hypertrophy in an effort to keep up production. This in turn compromises the ability of other areas of the adrenal gland to function at optimal levels. Secondly, as chronic stress persists the portion of the adrenal gland responsible for cortisol production can hypertrophy in an effort to keep up production. This in turn compromises the ability of other areas of the adrenal gland to function at optimal levels.

The Adrenal Connection It is hypothesized that Ritalin’s therapeutic effect results from it’s ability to increase availability of dopamine levels. It is hypothesized that Ritalin’s therapeutic effect results from it’s ability to increase availability of dopamine levels. Dopamine is a precursor to important neurotransmitters like epinephrine and norepinephrine. Dopamine is a precursor to important neurotransmitters like epinephrine and norepinephrine. A major producer of epinephrine and norepinephrine is the inner medulla of the adrenal gland. A major producer of epinephrine and norepinephrine is the inner medulla of the adrenal gland.

The Adrenal Connection

Cortisol and ADD Many people wonder why a stimulant medication like Ritalin helps calm an already hyperactive person Many people wonder why a stimulant medication like Ritalin helps calm an already hyperactive person It is because there adrenal function is low to begin with and their natural physiologic stimulus is already low It is because there adrenal function is low to begin with and their natural physiologic stimulus is already low The hyperactive behavior observed is a compensatory mechanism in an effort to reach a normal functioning state The hyperactive behavior observed is a compensatory mechanism in an effort to reach a normal functioning state

Blood Sugar and ADD/ADHD

Simple Carbs and Simple Sugars Breads Breads Potatoes Potatoes Pasta Pasta Processed Grains Processed Grains Some Fruits Some Fruits Refined Sugar Juice Candy Junk Foods Soda

Simple Carbs Simple carbohydrates are almost immediately broken down by the body into simple sugars Simple carbohydrates are almost immediately broken down by the body into simple sugars This results in a rapid influx of sugar into the blood stream This results in a rapid influx of sugar into the blood stream

The Physiology The sudden increase in blood sugar triggers a sharp increase in insulin secretion, which in turn rapidly lowers the sugar level in the blood The sudden increase in blood sugar triggers a sharp increase in insulin secretion, which in turn rapidly lowers the sugar level in the blood

Blood Sugar and Insulin

Blood Sugar and ADD High sugar levels can itself be activating and can trigger hyperactive behavior. High sugar levels can itself be activating and can trigger hyperactive behavior. Secondly, the quick release of insulin that leads to low sugar levels worsens low brain arousal levels of ADD subjects and aggravates behavioral problems. Secondly, the quick release of insulin that leads to low sugar levels worsens low brain arousal levels of ADD subjects and aggravates behavioral problems.

Take Home Message EAT MORE PROTIEN, BENEFICIAL FATS AND FRESH VEGEATABLES EAT MORE PROTIEN, BENEFICIAL FATS AND FRESH VEGEATABLES

Optimal Blood Sugar Curve

Back to Cortisol We know cortisol is the key hormone that triggers the body to increase blood sugar levels. We know cortisol is the key hormone that triggers the body to increase blood sugar levels. So this pattern of hypoglycemia serves as a further stress on the adrenal glands. So this pattern of hypoglycemia serves as a further stress on the adrenal glands.

The Gastrointestinal System

What does our GI system have to do with our brains?

Our GI System Our GI system is our barrier to the outside world Our GI system is our barrier to the outside world It’s job is to act as a selective filter It’s job is to act as a selective filter Something does not truly enter our body until it passes the cells of the intestinal walls Something does not truly enter our body until it passes the cells of the intestinal walls

Our GI System

Digestion Incomplete digestion of proteins can result in the production of large molecular by-products. Incomplete digestion of proteins can result in the production of large molecular by-products.

Incomplete vs. Complete

Digestion Some of these more complex structures are not easily utilized by the body and have a difficult time passing through the cell membrane. Some of these more complex structures are not easily utilized by the body and have a difficult time passing through the cell membrane. This means less absorption of nutrients. This means less absorption of nutrients.

Dysbiosis Our GI tract is normally inhabited by more than 500 species of micro-organisms. Our GI tract is normally inhabited by more than 500 species of micro-organisms. These micro-organisms play a large role in the defense of our GI system and in the breakdown of food products. These micro-organisms play a large role in the defense of our GI system and in the breakdown of food products. They also metabolize food products into vitamins and amino acids that feed the cells of the intestine. They also metabolize food products into vitamins and amino acids that feed the cells of the intestine.

Dysbiosis Incompletely digested structures, like the one in my diagram, can not be easily utilized by our beneficial gut bacteria. Incompletely digested structures, like the one in my diagram, can not be easily utilized by our beneficial gut bacteria. However, bad bacteria have special urase enzymes that can break these structures down. However, bad bacteria have special urase enzymes that can break these structures down.

The Problem The break down of these structures by urase enzymes cause ammonia by-products to be produced. The break down of these structures by urase enzymes cause ammonia by-products to be produced. Elevated ammonia blood levels have been measured in children with Autism, ADD and ADHD. Elevated ammonia blood levels have been measured in children with Autism, ADD and ADHD. Ammonia is a neurotoxin and further impairs neurological function. Ammonia is a neurotoxin and further impairs neurological function.

Dysbiosis Supplementation with beneficial gut flora and the use of digestive enzymes help to optimize gastrointestinal function. Supplementation with beneficial gut flora and the use of digestive enzymes help to optimize gastrointestinal function.

Diet and Food Sensitivities A large body of medical literature has indicated that hidden food allergy is a frequent cause of a wide range of physical and mental conditions. A large body of medical literature has indicated that hidden food allergy is a frequent cause of a wide range of physical and mental conditions. Furthermore, although the concept of hidden food allergy remains controversial, the evidence strongly suggests that identification and avoidance of allergenic foods can relieve a number of common and difficult to treat medical problems. Furthermore, although the concept of hidden food allergy remains controversial, the evidence strongly suggests that identification and avoidance of allergenic foods can relieve a number of common and difficult to treat medical problems.

Common Allergens Common foods that cause reactions are dairy products, sweeteners, corn, wheat, yeast, orange, soy, peanut, beef and chicken. Common foods that cause reactions are dairy products, sweeteners, corn, wheat, yeast, orange, soy, peanut, beef and chicken.

Wheat and Casein Some incomplete digestion by-products, like the ones from wheat and casein, have molecular structures that mimic opiod like molecules in the body. These opiod like structures can exert effects on the neurological system and aggravate symptoms of ADD/ADHD Some incomplete digestion by-products, like the ones from wheat and casein, have molecular structures that mimic opiod like molecules in the body. These opiod like structures can exert effects on the neurological system and aggravate symptoms of ADD/ADHD Some trials show as much as an 80% improvement in ADD/ADHD symptoms with just the elimination of wheat and casein from the diet. Some trials show as much as an 80% improvement in ADD/ADHD symptoms with just the elimination of wheat and casein from the diet. Some incomplete digestion by-products, like the ones from wheat and casein, have molecular structures that mimic opiod like molecules in the body. These opiod like structures can exert effects on the neurological system and aggravate symptoms of ADD/ADHD Some incomplete digestion by-products, like the ones from wheat and casein, have molecular structures that mimic opiod like molecules in the body. These opiod like structures can exert effects on the neurological system and aggravate symptoms of ADD/ADHD Some trials show as much as an 80% improvement in ADD/ADHD symptoms with just the elimination of wheat and casein from the diet. Some trials show as much as an 80% improvement in ADD/ADHD symptoms with just the elimination of wheat and casein from the diet.

Inflammation and Food Sensitivities Low level allergic reactions to food serve as a constant source of inflammation in the GI tract. Low level allergic reactions to food serve as a constant source of inflammation in the GI tract. Inflammation of the GI tract causes a compromise in the tight junctions of cells. This allows for the easy passage of large molecules directly into the circulatory system. Inflammation of the GI tract causes a compromise in the tight junctions of cells. This allows for the easy passage of large molecules directly into the circulatory system.

Our GI System

Consequence This constitutes a compromise of our selective filter and barrier. This constitutes a compromise of our selective filter and barrier. We now have environmental toxins, mercury, digestive waste and large proteins passing directly into the circulatory system. We now have environmental toxins, mercury, digestive waste and large proteins passing directly into the circulatory system.

Food Sensitivities The elimination of irritants is essential in the restoration of tight junctions and GI integrity. The elimination of irritants is essential in the restoration of tight junctions and GI integrity.

Recap Eliminate food allergies and inflammation to restore integrity of filter Eliminate food allergies and inflammation to restore integrity of filter Improve digestion to enhance nutrient absorption and eliminate incompletely digested protein by-products Improve digestion to enhance nutrient absorption and eliminate incompletely digested protein by-products Establish strong colonization of beneficial micro- organisms like acidophilus and bifidus species Establish strong colonization of beneficial micro- organisms like acidophilus and bifidus species

Essential Fatty Acids

Omega 3 and Omega 6 Essential Fatty Acids are compounds in our body essential for proper functioning. Essential Fatty Acids are compounds in our body essential for proper functioning. They can not be synthesized by the body so they must be obtained via the diet They can not be synthesized by the body so they must be obtained via the diet

Essential Fatty Acids All cells in our body are enveloped by membranes primarily composed of essential fatty acids. All cells in our body are enveloped by membranes primarily composed of essential fatty acids. Proper functioning of this membrane is necessary for the health of our cells. Proper functioning of this membrane is necessary for the health of our cells.

The American Diet The average American Diet provides a ratio of about 300:1 Omega 6 to Omega 3 fatty acids. The average American Diet provides a ratio of about 300:1 Omega 6 to Omega 3 fatty acids. The ideal ratio for our bodies in about 5:1. The ideal ratio for our bodies in about 5:1. Omega 3 acids are severely lacking in an average diet. Omega 3 acids are severely lacking in an average diet.

Omega 3 Some of the highest concentrations of Omega 3 fatty acids are found in the brain and nervous system. Some of the highest concentrations of Omega 3 fatty acids are found in the brain and nervous system. There has been encouraging research revealing improvement of ADD/ADHD symptoms with proper Omega 3 supplementation. There has been encouraging research revealing improvement of ADD/ADHD symptoms with proper Omega 3 supplementation.

Where are the good fats found? Cold water fish is the best source of Omega 3 fatty acids. Cold water fish is the best source of Omega 3 fatty acids. Beneficial fats are also found in freshly shelled nuts, flax seeds, and avocadoes. Beneficial fats are also found in freshly shelled nuts, flax seeds, and avocadoes. Ample sources of these fats should be a part of every diet. Ample sources of these fats should be a part of every diet.

A Case Study

14 year old male presenting to the clinic with a pervious diagnosis of ADD 14 year old male presenting to the clinic with a pervious diagnosis of ADD Mom reports problems at home with fighting with siblings, not staying on task and lots of mouthing off Mom reports problems at home with fighting with siblings, not staying on task and lots of mouthing off School reports slipping grades, not staying focused during class and problems with teachers School reports slipping grades, not staying focused during class and problems with teachers

Initial Treatment Plan Modify diet to eliminate all dairy products and sources of refined sugar. This meant no juice, soda pop or candy. Modify diet to eliminate all dairy products and sources of refined sugar. This meant no juice, soda pop or candy. Coached mom about cooking with more whole foods like fresh organic vegetables, whole grains and quality meats Coached mom about cooking with more whole foods like fresh organic vegetables, whole grains and quality meats Also discussed importance of a good breakfast Also discussed importance of a good breakfast

Initial Treatment Plan Support Adrenal Glands. This was done with a multiple B-vitamin complex and a regime of going to bed at the same time every night and waking up at same time every morning. Support Adrenal Glands. This was done with a multiple B-vitamin complex and a regime of going to bed at the same time every night and waking up at same time every morning. Further support for cortisol rhythms was achieved with an essential fatty acid supplement that help modulate the growth hormone/cortisol interaction. Further support for cortisol rhythms was achieved with an essential fatty acid supplement that help modulate the growth hormone/cortisol interaction.

Treatment Plan Cont mg of magnesium once a day. 150 mg of magnesium once a day. Daily supplementation with beneficial GI micro- organisms. Daily supplementation with beneficial GI micro- organisms. Homeopathic Remedies to aid the body in the breakdown and elimination of toxins. Homeopathic Remedies to aid the body in the breakdown and elimination of toxins. We also advised mom to discontinue topical cortisone cream for a small patch of eczema on his leg. We also advised mom to discontinue topical cortisone cream for a small patch of eczema on his leg.

1 month follow-up Little change in overall behavior. Things still seem to be getting worse Little change in overall behavior. Things still seem to be getting worse The child was very good about taking the supplements and adjusting to the new diet without much complaint The child was very good about taking the supplements and adjusting to the new diet without much complaint Patch of eczema getting slightly worse Patch of eczema getting slightly worse Homeopathic remedies changed and patient advised to continue protocol for 1 more month Homeopathic remedies changed and patient advised to continue protocol for 1 more month

2 month follow up Behavior starting to improve. Mom notices better ability to stay on task at home and less talking back Behavior starting to improve. Mom notices better ability to stay on task at home and less talking back Child comments that he feels he can now think before he speaks or acts. Child comments that he feels he can now think before he speaks or acts. Treatment protocol continued for 1 more month Treatment protocol continued for 1 more month

3 month follow up Mom can not believe it is the same child. Home life dramatically better, school life greatly improved. Mom can not believe it is the same child. Home life dramatically better, school life greatly improved. Child feels it is easier to concentrate and does not feel as agitated as he used to. Overall feels calmer and in more control. Child feels it is easier to concentrate and does not feel as agitated as he used to. Overall feels calmer and in more control.

Dr. Kevin Passero, N.D 203 Ridgely Ave Annapolis Md