Medical Presentation: ADHD: The Genetic Basis of Dietary Supplementation

okay we're gonna get started now um I'm Dr Richard Bowles and the talk is on ADHD the genetic basis of dietary supplementation and first of all who am I I am many different people to many different many different things to many different people um I think of myself predominantly as the physician I am an MD geneticist that treats patients most of the time I was 20 years at Children's Hospital Los Angeles and at USC um University of Southern California as a geneticist I'm right now in a group prac

tice working at neurobilities which is physically located in the Philadelphia area but everything is done by Zoom so I do I see patients across the country and in and actually interact with Physicians around the world in terms of genetic testing I'm also the chief medical and scientific officer of neuro needs I'm one of the free founders um narrow needs is the company that makes a bunch of products that you can see on there and we'll be talking about those products and how they interact with ADH

D I'm the primary person who designs these products but I work with a lot of other people including Dr Rossignol Dr Fry and many others on that this talk is coming to you through neuro needs I was the medical director of DNA sequencing companies that's really what I do now is I don't work for a DNA sequencing company I in practice and I order from these companies whole genome looking at the entire DNA and then based upon that figure out what the cause of disease in that person is and how to trea

t that so it's based upon a lot of this talk a lot of how I treat ADHD is based upon what the underlying genetics is in a very large number of patients with ADHD that I've seen and of course that other people have seen and put in the literature I also do some expert witness situation for legal cases particularly like Munchausen by proxy situations and I'm still writing on papers um in particular my experience in autism cyclic vomiting syndrome um chronic fatigue syndrome I'm hoping to get to ADH

D soon in terms of writing papers but I was at University of Southern California I was faculty with a laboratory and NIH funding and all that sort of stuff so um I'm going to do very few case reports this time unlike my usual because there's a lot of information to have here today is going to be the lecture I'm going to be giving you the scientific basis what really is ADHD and what does that mean about what you can do about it the next lecture with the next one which will be next month and um t

he exact date and time to be determined but we have these talks and neural needs every month now so approximately a month from now on probably on Wednesday will be more of a discussion including a physician there and bringing in the audience to talk about ADHD in general this talk as well as just in general how you treat it and how it fits in with dietary supplementations medications and everything so today is the lecture um it will be provided on because I know I'm going to kind of go through t

hings pretty quickly but the idea is to give you an overview and the slides will be available on our sites on our websites so that you can go later and look at something if you saw something on a slide oh I want you know I want to think about that or I want to get that website so I can check it out so the with that having been said um the first case report is on Carter um he presented it one year of age when he stopped developing speech he was later diagnosed with autism as is often the case wit

h people with Autism biochemical Laboratory Testing suggests the possibility of a mitochondrial disorder I would say 80 to 90 percent at least of the patients I see with autism have a mitochondrial disorder DNA sequencing revealed a fairly common variant one percent of people have um the isoleucine to to veiling variant it's amino acid 253 and the trap one gene which is a gene which is involved in it's a chaperone which helps proteins to survive under highly oxidative conditions in the mitochond

ria um in Silicon modeling which was done by colleagues at Georgia Tech um predicted that the mutations was in The Binding site for ATP and that gansitron which is known by the trade name of kaitro that it will bind to the mutant or the abnormal trap one molecule but not to the normal trap one molecule or protein and therefore we would turn off the mutant protein and hopefully to help with the disease um Carter improved dramatically on kitral you can see some of the things here became more talka

tive more clever more focused less aggressive less sensory integration problems got along better with his older brother and more tolerant of really conditions in general he went from being a very severely autistic kid that the parents could never dream about going out to to a restaurant to being able physically able to handle sitting at a restaurant staying in the seat eating not throwing his food and really being you know being part of the family there it made a huge difference I'm aware of fiv

e different times he was taken off a kytrol mostly because of Nationwide shortages with the drug and each time he regressed and every time that he's on the drug he got better again so why am I talking about this kid with autism and an ADHD talk because on kitral he has ADHD some people can look at this as sort of a little ought you know like autism minor or something like that but they really are separate conditions his autism issues really receded tremendously and he's mainstreamed in over half

of his classes now his language is excellent his social skills are pretty good um but he's very highly inattentive impulsive and hyperactive so really when he's on kaitrile he's an ADHD kid the ADHD is there when he's autistic but the autism is so severe that it's really kind of not noticed as much and methylphenidate is the usual it's a very common drug that she's done that has many different trade names including Ritalin that has actually helped his ADHD um and so I wanted to show you that yo

u know ADHD and autism often go together um first of all some more um caveats about the lecture is that um this is personalized medicine that I do is that you look at the DNA code in an individual and treat that individual or who they are not as a member of the group not it's just a kid with autism or a kid with ADHD but a child with this mutation in that Gene and as such it's very it's individualized and kaitro is not approved by the H by the FDA or any other regulatory Agency for the treatment

of autism this was based upon personalized medicine um there's also there's no official recommendations for genetic testing and autism ADHD or any neurodevelopmental disorders that's not going to stop me from saying what I think are you know what I think is the standard of care and what I think should be done but there are no official recommendations and then I am a part of neuro needs that makes many of the products for neurodevelopmental and other disorders including ADHD so moving along with

that this is a slide that really kind of underlies this entire lecture is that these neurodevelopmental disorders are not separate in that you don't have one or the other and you have to figure out the diagnosis they often occur together you can have any of the three autism ADHD or anxiety without the others or you can have combinations and most of my patients are in this area here that have all three of them it's a better Venn diagram would be the circles are separate but they're much more clo

sely packed together so the overlap is larger than the other areas here's some other Venn diagrams here you can see that within ADHD you have anxiety disorder depression conduct disorder um there's a lot there's different overlaps here and then here's another one that's looking at different genes like autism will overlap all of this as autism will overlap everything in the brain so it will overlap epilepsy intellectual disability and also things that you would think of as separate like schizophr

enia as well as migraine depression anxiety all of these things they really overlap with each other so all of these here are different types of brain disorders um in ADHD um actually 50 of people with ADHD have either anxiety or depression these don't add up because some people have both obviously but they are very tightly correlated in that if you have one you're not necessarily going to have another but you're likely to have another so what is ADHD how does this differ from autism or from any

of the other conditions this comes from DSM-5 the actual Diagnostic and statistical manual that people use to say you know what is the official diagnosis throughout the world and for ADHD you have inattention and hyperactivity um just add sometimes is called um either just a a d d without the H with it has the inattention only sometimes it's called predominantly inattentive presentation of ADHD so there are all these different words but basically what do you mean by inattention if you look at th

e green things here that's what we mean by inattention a lot of people will say oh there's nothing wrong with the tension he can play video games all day um well a kid that can play video games all day probably does have ADHD that's what they like to do because it takes their the video games is constantly grabbing their attention ADHD is an inability to put your attention where you want it to go where you feel it should go where your executive functions say this is what I should be doing um putt

ing your attention on things you love that's easy to do people with ADHD do that just fine so here are some other ideas you know careless mistakes is they're not paying attention I'm not seeming to listen again not paying attention not following through on instructions trouble organizing things reluctance to do tasks easily distracted forgetful these are some of the things even losing things a kid loses things all the time this is what we mean by inattention and yeah there's exact diagnostic cri

teria if you have six or more of these before age 17 Etc but this gives you an idea so if you just have the inattention some people call that add or the um predominantly inattentive ADHD to get the combined presentation you have inattention plus hyperactivity slash impulsivity think of these two as together hyperactivities of the body and impulsivities of the mind but basic things are going too fast fidgeting that's what you often see in older like adolescents or adults they're not jumping all o

ver like the little kids are but they're fidgeting or squirming they keep leaving their seat a lot of younger kids will run around climb things when they play they do not play quietly I'm always on the go talking excessively blurting out an answer before a question is completed trouble waiting their turn interrupts others so this is really hyperactivity and impulsivity is one concept that they go together if you have this plus inattention then you have ADHD it doesn't matter if you have intellec

tual disability or if you're in all honors classes doesn't matter if you have autism or you're a social butterfly it doesn't matter on anything else this diagnosis is based upon the criteria regardless what else you have obviously there are always criteria you have to have had symptoms before age 12. yes there is adult ADHD but when you look back in time they had the symptoms beforehand and two or more settings so this is not just oh he does great at school and pays attention but at home he won'

t listen to me that's not it um it has to there's many different settings here usually it's home and school are the settings but I mean for an adult it may be work it may be social activities it has to reduce the quality of functioning it's not just the person is like a fun person has lots of ideas and is all over the place but does great at school great at work great at home that's not a disease that's just personality and it's not better explained by another mental disorder that doesn't mean t

hese things can't happen at the same time but if another mental disorder explains everything then you don't have that so with this criteria how many people have it well a lot five to seven percent of children about half of that for adults worldwide in the United States um estimates are between four about four million children and about 6 million adults have ADHD I mean that's really big this is a common disorder a lot of people have it and at least half the people that have it don't even know it

so you saw this before I'm showing it again because what is ADHD that's different from anxiety that's different from autism that's different from conduct disorder that's different from depression it's different from everything else what makes it ADHD what it is is executive function the the little executive where in the the suit and tie and everything that says maybe we should be doing our homework now or maybe we shouldn't be talking so loud or maybe we should be doing something is that execut

ive saying you know it's the emotional centers are just going wild and they're not listening and I'm not just talking about like the ID the um it would also be like the superego it's not listening to that either um you have too much anxiety because you can't tell yourself you know this is really not an issue I shouldn't worry about this at all but you are worried because the executive function is not able to control the rest of the brain and these are really the three areas that are really if yo

u break it down working memory cognitive flexibility inhibitory control inhibitory control is pretty obvious I explain that is maybe I shouldn't be doing that cognitive flexibility you you take the same tool and you like a hammer and you just apply it to everything it's they have a hard time saying well maybe I'm thinking at this from the wrong direction maybe I ought to reconsider it from another angle and then with working memory you have a hard time with working memory because they have a har

d time concentrating on what they're thinking about so there's only so many things you can have in the head at one time if you're being distracted so that really is what ADHD is his executive function it's the prefrontal cortex of the brain that's where the issue is another way to look at this is the poop pathology test which is I know it's so tongue-in-cheek but I actually think it it really can tell you something each of the characters on Winnie the Pooh have a different pathology ADHD is defi

nitely Tigger totally distractible and jumping all over the place poot is not hyperactive but definitely distractible piglet has anxiety rabbits certainly OCD Rue is kind of a little bit out there you know staring off into space Eeyore is depression and of course Christopher Robin is believe you know is making all of this up in his head and so he's you know it's not quite there so schizophrenia but the idea is is that people do not have one or the other but people have a common have a little of

this a lot of that little of this none of this medium amount of that is in each person there's it's a more complicated than that is that each and every one and has different amounts ounce of it and this by the way is me when I took the test I I think of this as sort of the nerd triangle sort of thing I'm kind of out there kind of you know make sure everything's right and maybe a little spacey um but this is um this is how you get to it um and if you just do poop pathology test and and Google you

can get to it really easily it can tell you something but the ideas is that those conditions are not separate diagnosis but they're really each and every one of them is a spectrum so ADHD it's a very serious condition um I have to admit that before one of my sons developed ADHD and in particular it became really severe that I never really thought of this as such a serious condition oh it's just ADHD that's really common that's you know everything else is much worse in this area but it's that I

was wrong on that ADHD is a serious condition um these this is from a paper and all of these here are worse in ADHD this is the normal person here the average person so and this is the average for a person with ADHD and these are the air bars if it doesn't cross this line that means it's statistically significant and on this everything that is statistically significant they put on here a lot of things they didn't put on here because it crossed the line but I mean so you can say well like college

completion and years of schooling that's a lot less than people with ADHD well that makes sense you know how well they are subjectively I mean yeah that makes sense a depression neuronicism that's higher but look at all of this stuff obesity diabetes um the bad cholesterol is elevated the good cholesterol is low the body mass index that's because the executive maybe I ought to not have another Pop-Tart maybe I shouldn't have another piece um a pizza uh maybe I should eat better if that's affect

ed um maybe I shouldn't smoke lung cancer is much higher in ADHD because of smoking number of cigarettes per day whether you smoked or not um and then there's some things like of all of this stuff here what is the most significant age of first birth obviously impulsivity goes into that in having sex too early not using birth control Etc but that's actually the most significant change here is how old you are when you have your when you father or have your first child um and then it affects the pa

rents age of death because if you have ADHD it's highly genetic it's likely one of your parents house but not by any means a certain because of all these things are bad there there's early mortality and people with ADHD their mother and their father um have shorter lifespans so this is a really serious disease and the reason I'm showing you this is to say that this is this needs to be treated as a serious disease it is serious and you need to treat it serious and it's not just like oh my kid wit

h autism also has ADHD but that's really not that important it is important it needs to the autism is important the ADHD is important it needs to be treated separately I mean they're treated with different medications or supplements to some degree it needs to be taken um seriously obviously injuries traffic accidents and things like that impulsivity um that increases not only that unemployment divorce suicide age related risk factors it really is a disease that is not just affecting their well-b

eing or their ability to up to work in school but it affects pretty much all aspects of behavior and thus it affects all aspects of life so I mentioned that it's genetic these are all different studies and how inheritable it is if it goes all the way to 1.0 like a few of the studies do that means it's entirely inherited entirely genetic with absolutely no in component of environment um most conditions are environmental and inherited like heart disease is about 0.2.3 there's an inherited componen

t but it also depends on how you live your life um cancer it's inherited but also depends on how you live your life ADHD and autism are the most inherited of all common disorders that doesn't mean there's not an environmental component but that does say that there's a very high heredity component and that's saying that this is genetic and I'm a geneticist and so when I go into the genetics of that I'm not saying that genetics is all of what it is and that there's nothing else in there there are

environmental components but the genetics is most of what makes ADHD you're pretty much conceived with it or born with it um which genes very complicated don't need to go into this but you can look on the right hand side those are the genes most associated with it it's pretty much all different things in a brain wiring the brain wiring the synapses dopamine levels cellular recognition in communication between the cells to line up to build the the um the neural networks what I'm going to be showi

ng you is I'm just showing you all these genes and everything is that the genes that predispose towards ADHD are the genes that are needed to build and maintain a brain that's what it is they're not separate genes they're not ADHD genes they're just brain genes and where there's a problem with a brain Gene you're more likely to get any brain disorder ADHD autism anxiety depression any of them so the genes that I showed you on the previous list all of these here are associated with ADHD but that'

s only 10 percent of of what the of ADHD um another 10 percent are variants I didn't show you on that slide but all common variants in all 23 000 genes the common variance is only 20 that means eighty percent of of ADHD is not in the common variance um what are they they're rare variants mostly copy number variants are rare large variants like a deletion and part that's missing a part that's added that could be 10 nucleotides a hundred a thousand a million nucleotides these are all increased and

you say well what genes are involved again involved in electron transport energy metabolism energy metabolism again energy metabolism ion channels um that's um with it that's how the electricity works in a neuron ion channels again um but these are genes that are important in operating the brain in general um and then these genes overlap with the genes for autism schizophrenia bipolar depression you name it it can be um anxiety it can be um epilepsy it can be um migraine headache the genes for

ADHD overlap with all of these other conditions the overlap with autism is very great but it also overlaps with the others because these are genes in general that are needed to build and maintain a brain um this is the million dollar that's actually the cost machine that I use um that I that the Laboratories have that when I order a whole genome sequencing to sequence all of the DNA in somebody all three billion nucleotides this is what the machine looks like and this is about this part here is

about the size of a refrigerator so it's like two refrigerators next to each other in size to give you an idea of the scale of it and this machine can read all of the DNA of a person in about four hours okay um bear with me for a second um I'm going to be talking about autism again but I'm going to bring it to ADHD very quickly um I put my research my um clinical data together less than a month ago on autism um in the from January through August of this year 2022 I saw 20 patients with autism wi

th or without other problems and those 20 patients had whole genome sequencing done at variantics that's the lab I use um and also Trio that means the mother and the father were sequenced as well which is necessary because um to be able to find a new mutation and so of these 20 with autism a monogenic that means a single Gene causal it causes disease and the variant is considered to be pathogenic or likely pathogenic it's very very highly likely that that variant is the cause of disease in 15 of

the 20. so 75 percent of the patients this year through August um have the DNA said this is it this is the cause of your disease about half of them the diagnosis was listed on the laboratory report and half of them it's because I went back and did all the raw data myself through the and and found something that had been missed by the lab um most of the ones that were missed um were genes of Uncertain significance and I did additional research and found that they are indeed likely very highly li

kely to be related to it um it was more likely that I found an answer if the if they had intellectual disability that was at least moderate or worse um 92 percent 11 out of 12. but even if those with a with mild intellectual disability normal or above normal IQ almost all of these were normal um intelligence still four out of eight had an exact diagnosis so it's still 50 in people that let's say they just have you know like ADHD or something like that without intellectual disability um because t

icks often are pans which is an immune system problem there certainly were more diagnosis and those didn't list ticks and those that did but in so I can go into that in detail but I want to show you these are the genes which had of the 15 that had the mutations that cause disease and they're in all different Pathways but there's a couple of things that I want to show you is everything in color is a treatable pathway and every single one of them I said this is the cause of autism here's the treat

ment let's try it out historically about 50 percent of the time the treatment that's based upon the gene makes a difference a significant difference in the patients better and about 50 percent doesn't it either I can't figure out how to treat it or um there is no treatment like some of the ones that are not colored um or the treatment doesn't work so most of them are treatable doesn't mean all of them got better historically I'd say I do the whole genome sequencing about half of them will get be

tter but what I want to show you is that these have to do with them with um mitochondria and then the cation channels involve the mitochondria protein turnover involves the mitochondria and so does the amino acids so all of the different the three the four colors here which is most of them are either primarily or secondarily involved mitochondria and that they are treatable Pathways the other thing I want to show you is that all of the red ones also have ADHD the the ones that are in Gray their

mental retardation is so severe I don't know if they have ADHD or not um it you can't tell um if if they can't do anything you can't tell if if if they have it this one did not one of the pain one of them did not um so when I'm talking about this is the genetics of autism this is the genetics of autism plus ADHD and it's all different Pathways and it's mostly treatable um here I want to give a case report one more case report um sometimes there's not a single diagnosis oh one other thing I want

to mention these here were all de Noble mutations that means the parents didn't have it it was a new mutation in the child and you can only tell that by sequencing the parents I mean these were inherited variants like I'm X length the mother is a carrier and then had an affected son or autosomal recess that the parents are unaffected carriers and the child got a double dose so it's mostly de novo meaning a new mutation some of them are inherited um but there's sometimes there's not a single diag

nosis here's a 12 year old has ADHD but has other issues as well um and the whole genome sequencing found a mutation in the transporter for glucose 6-phosphate across the endoplasmicent reticulum that's pathogenic for glycogen storage disease type 1B um and the p and he has hypoglycemia lactic acidosis he never fully recovered from was considered Encephalitis which is probably hypoglycemia he's got other issues and all of these issues in green are because of glycogen storage disease and that's t

reatable in a completely different way as she would normally treat that with with a very strict diet but in addition to that he's got pancytopenia pancytopenia is anemia red cells blight bleeding low platelets and immune system problems combined immunodeficiency from abnormalities of neutrophils and monocytes and lymphocytes all of these come from the blood cells so he had he has to see the ID diagnosis he's had multiple infections pancytopenia all of these are down and there is a mutation a fra

meshift variant so that absolutely causes disease and the re in a gene that's involved in Breaking the DNA so that you can make antibody genes and then that's pathogenic for immunodeficiency so this patient you know you look at this and he says well what can cause all of this well it's two different genetic disorders nothing will cause all of that so there's not always a single answer so treatment overview um and I'm going to be showing a slide similar to this every once in a while and a little

bit different so how do you look at this from neurodevelopmental disorders in general so this is ADHD and autism well you need to address the factors that are important for good health in everybody if you're not sleeping it's going to be really hard to fix anything if you're not exercising if you have really bad diet and if you're taking toxic substances Tylenol many of you might know is is somewhat toxic um alcohol um you know narcotics there's a smoking there's a lot of you know bad stuff out

there so if you're not if you're not doing the right things and you're not avoiding the bad things it's going to affect Health in general and it's going to be really hard to fix anything if you're in bad General Health so address factors that are common to neurodevelopmental disorders in general like autism ADHD mitochondrial dysfunction I'm going to go over that a little bit more it's very critical neurotransmission ion channels inflammation autoimmunity and others including the gut microbiome

these are areas that come up over and over again with neurodevelopmental disorders and then address the areas that are specific to the individual genetic defect in that person um and that requires Trio that's mother father and childhood genome sequencing to figure out the underlying cause and then an out of the box approach okay this is the cause it's never been seen before or it's been seen five times in the world before how do we what do we do about that um taking a look at the literature taki

ng a look at the biology and trying to figure out how to to do something okay so going to be talking now about mitochondrial dysfunction which is one of the things that's really important but I think it's the most single most important one um in my the basics in mitochondrial dysfunction um you get neuromuscular disease because the nerves are electrical muscle requires power as well it requires a lot of energy to run the nerves and the muscle so if you have a problem with energy metabolism most

commonly it's a brain disease it can be the rest of the nervous system as well the peripheral nervous system dysautonomia enteric nervous system of the gut but also you can see muscle problems in adults with a known mitochondrial disorder sixty percent of them have a mental health disorder many different ones so there's definitely mitochondria affect the brain because the brain requires a lot of energy and the brain is the site of Mental Health and how do you treat um these disorders antioxidant

s are the main therapy antioxidants are used in brained orders in general they're being used today in Alzheimer's Parkinson's Huntington autism schizophrenia depression all of this stuff OCD antioxidants are critically important for brain disease but you know what about ADHD um I'm supposed to be talking about ADHD this time well ADHD is closely related to autism depression and schizophrenia some of the other conditions it's a little bit you know so and these are all disorders in which mitochond

ria is important so ADHD is closely related to many other conditions of which mitochondria are important maybe it's important in ADHD as well and how does that inform on treatment well you can imagine that maybe is reality these are only some of the scientific papers um that show that ADHD involves energy metabolism mitochondrial dysfunction the ones that I have on the top ones are my favorite but there are a lot of scientific studies that show that ADHD does involve mitochondria energy metaboli

sm increase oxidative stress in particular if the mitochondria are not working right you have increased oxidative stress Okay so ADHD is serious and therefore you want to treat it um most people with ADHD are put on medications I'm not against medications my son is on it um is I'm just saying that medications without supplements might not be the right answer is that methylphenidate is the number one drug used in most of the world for ADHD it goes by a hundred different trade names including Rita

lin but there's a lot of other ones out there and each preparation is a little bit slightly different in various ways particularly about how much is is given out at what time of the day but this drug adversely affects oxidative metabolism this drug causes mitochondrial dysfunction so if you already have mitochondrial dysfunction you're put on this drug it's going to get worse just don't take my word for it all of these papers say that this is fairly well known these papers have been around some

of them 2006 2008 2007 some of them are more common there's a review this one here so I'm not saying not to use drugs this is a serious condition you need to treat it I generally in my patients start with supplements and then use drugs if needed some patients the supplements work great and they don't need drugs some of them they need drugs but the supplements they need less drug so one way with the supplements is some people don't need the drug or they need less drug but even if they need it the

drug you really kind of need to fix the mitochondrial dysfunction before you can make it worse with medication anyway that's my that's my philosophy so you're saying that mitochondrial dysfunction is really important in autism it's really important ADHD how do I know if my kid has it um these this is a slide I use to to I talk to medical students about it says well how do you recognize mitochondrial dysfunction in general for this is for first-year medical students so this is people that are go

ing to go into every different field it's not just for Pediatrics it's certainly not just for autism or something or for ADHD but you can see these this is a slide I show the medical students mostly brain but also muscle to some degree what muscle all muscle including heart muscle eye muscle Etc but you can kind of look down the list there's I could put 20 different slides like this and not cover half of what I know about can be caused by mitochondrial dysfunction the reason is is that every cel

l of the body needs energy for pretty much everything it does and if it doesn't have the energy right things are not going to go very well and if you have other mutations and other genes plus environmental insults you could get disease so think think about you know mitochondrial dysfunction is putting stress on the entire body all cells all organs it won't cause anything but it predisposes towards disease throughout the whole body particularly in the nerves mainly the brain but the rest of the n

ervous system and in the muscle how do you treat mitochondrial dysfunction well you can increase energy Supply and there's a lot of the cofactors and vitamins that do that here are some of them exercise will build more muscle and make it and give you more power I'm decreasing energy demand um I say to people you know you need to live your life and I don't want you to live like a Hermit that will just make it like a couch potato things will get worse because she'll have less muscle over time and

more fatigue but maybe you shouldn't go running and drink alcohol on a day that you're sick that it's 105 degrees outside you have an asthma attack and you have spinal exams coming up the next day try to avoid high energy demand situations try not to pile them on top of each other and those are some of the high energy demand situations antioxidants that comes up over and over again this is the antioxidants the mitochondrial dysfunction causes a pro-oxidative environment the antioxidants fight th

at to go in the other direction the pro-oxidants damage DNA protein membranes Etc and then of course you treat the symptoms treat the mitochondria but also treat the symptoms and so many of these are medications and I can go I could show 20 slides of how to treat the symptoms but that's the general idea okay um just a little introduction onto the next thing is that what does the data show about in ADHD pacifically and dietary supplementation and the California desert can occasionally be very bea

utiful and this is my little girl three years ago it's a lot bigger now here is the publication I'm going to be showing you some some snapshots here then I added some commentary acetyl carnitine if you want to go back and see the slides you want to see the literature for yourself you know don't take my word for it what did the actual papers show here they are but in two studies acetyl carnitine was Superior to Placebo it's like a sugar pill not in ADHD um B6 and magnesium are often given togethe

r um one study on b6n magnesium together um showed that it was effective and also magnesium is deficient in most people with ADHD hair gives you not just what you ate today but long-term deficiency free studies on zinc two of them it was beneficial when it wasn't essential fatty acids there are eight studies and this this is some DHA and EPA I'll go into this a little bit more but six of the eight studies showed that essential fatty acids were were helpful so putting them together here instead o

f spending like 20 minutes on the data um and I'll show you where you can find all the data because it's on my website um ADHD is related to oxidative stress suggesting antioxidant therapy in general might be helpful acetyl carnitine magnesium B6 zinc and essential fatty acids have been shown many Studies have shown that vitamin D is deficient in ADHD suggesting that might be helpful and then there are three other ones here that have been tested in many other neurodevelopmental disorders includi

ng autism and they're used a lot in autism and they may or may not be helpful in ADHD based upon the fact that they're helpful in autism Coq um folate which is B9 and b12 but given the fact that they're important in the mitochondria I think that they probably are important ADHD and then one copper copper is actually high in ADHD copper supplementation might not be the way to go unless it's carefully under a doctor's prescription some doctors use very high dose zinc and they use copper to balance

that out and I'm not talking about that in that case it's under a doctor that's important but I wouldn't just willy-nilly go buy in huge doses of copper it's already high so if you look at the grain at the bottom here the data suggests that you know a comprehensive approach for not just taking one thing but taking several things is a reasonable way to to attack ADHD from a dietary perspective and this is I'm going to show you an assembly line the turn of the century over 100 years ago the turn

of the century 20 years ago Ford Motor Company Hyundai cars are built a little bit different than they used to be but the basic idea is the assembly line what if you give this guy a bunch of vitamins are you going to make more cars and you're just going to make more chaos what if you put an energy surge in this machine you're not making more cars you're making more chaos giving extremely high amounts of One supplement may not be the way to go you say well is energy really on an assembly line wel

l here are you might remember this from high school biology the electron transport chain the Krebs cycle this is an actual photograph now the color are computer simulations but this is an actual photograph of the electron transport chain and the Krebs cycle they're actually integrated together it is an assembly line electrons enter one place and they leave in the next um the idea with an assembly line is you got to give them all vitamins if is that I find far fewer side effects if you give a who

le bunch of different things than if you give a whole lot of one thing um Jim Adams published a study over 10 years ago in autism that showed that a vitamin mineral supplement is helpful but this is an Autism I want to show you that hyperactivity is one of the for is one of the three main changes the three major changes he saw was hyperactivity tantruming which you can say well that's sort of impulsivity and receptive language so three of the major changes he saw are really in the ADHD category

um Bonnie Kaplan has been looking at this mostly in adults with anxiety and depression and other psychiatric disorders and has found she published this paper here that showed that um explosive rage um was helpful in two children um her vitamin cocktail which actually is very similar to the atoms formula and very similar to my formula because it's pretty much a Mito cocktail with a whole bunch of different things in it but I have a whole lot of kids that I've seen that the major problem is episod

es of rage and then they go crazy and some of them are very violent and they it does respond to dietary supplementation in the vast majority of cases I also do DNA to find the underlying cause and treat that as well um and then embody um found out that um safety and tolerability um Dr Adams found the same thing is that if you give like 40 different um vitamins and minerals together that it's very safe and tolerated and people with different diseases in different ages and their blood levels show

no problems with the liver or kidneys or anything and I've noticed I've been doing this for years in my own patients so I've never seen any significant side effects so what I have done is taken the information based upon the latest some genetics to design the product line of neuronates um and these are the people and there's about about half of them are on the slide we need to make another slide that adds a whole bunch of others including there's a lot more women that are involved Dr griesbach i

s um an ADHD doctor but she does other things as well she's also my son's doctor um that treats that and then you probably you might know Richard Frye um Michael Ellis Mark Mintz and some and this guy here Dan Rossignol um he's been involved in this Jared skullron and J.R I'm Kobe um they are all different people in different areas most of them are pediatricians not all of them and they have helped me to design these products so Spectra needs us in a powder form comes in two flavors lemon and Be

rry has 33 active ingredients it's the mitochondrial cocktail energy needs is very similar but it's a capsule form I recommend this in anyone that can swallow 40 active ingredients it's got a little bit more to it um coenzyme Q10 is extremely important coenzyme Q10 comes in two forms you pick one all and ubiquinone you don't want the nun Jared skull run showed me that that is so you want to avoid the nun this one is five times more bioavailable in studies it's more expensive it's about twice the

price but it's five times you need five times less of it to get the same blood level so it's really cheaper and all this is really the Coq that's needed there's very this is not in the powders or the capsules here because it's an oil it doesn't mix in the powders or there's powder inside the capsules as well other issues is like um do you want soy in it versus limoline that's the oil the lemon peel can you swallow a small capsule this is the my cue needs here is ubiquinol in limoline oil so it

has Superior bioavailability to most of the products out there and and it's and it's a very good price compared to the other premium products that have high bioavailability and they're much smaller gel capsules than many of the um the competitors omega-3 fatty acids um they have many different roles including an inflammation I showed you a study that six out of eight studies showed that they were helpful and um in ADHD I'm in one of those studies on with some it's actually it's not one of the st

udies it's a meta-analysis of looking at all the studies together um if you just throw that into Pub into Google you can get it Improvement in hyperactivity lethargy and stereotyping that's like doing the same thing over again like hand flapping um the the two major forms are EPA that's what it's really called in DHA and that's the real name um it can have a there are taste issues um with it um so that it's best to take it in capsules if you can there are ones out there that are in liquid but th

ey I'm not aware of any any liquid soy any liquid um Krill product so I'll get to that um Omega-3s are very helpful in the brain but they're also helpful in General Health so for blood pressure for a cardiac function for um and also skin hair and nails they're important for blood sugar and a lot of other things so what often comes up as fish versus krill most of the popular brands out there are fish oil fish oil has some major advantages fish is a lot less expensive than Krill so the premium Bra

nds they're really expensive Brands out there are those some of them come down in price recently they have very high dose fish oil so what they try to do is just overwhelm the membrane to just throw Omega-3s into the entire body to try to not just to to circumvent a deficiency yeah most people that don't eat a lot of seafood are deficient in this if they don't take a supplement but to put a lot of Omega-3s to help the health beyond that of just a normal diet and so that's important for the rest

of the body but the thing is is that fish oil the Omega-3s are bound to triglycerides and it cannot enter the brain it's impossible to enter the brain what it needs to do is that it goes to the liver it converts it to a phospholipid and that gets into the brain so that's fine if you're trying to reverse a deficiency but when you're trying to throw you're taking your premium product that's extremely high dose and hope that a whole bunch of it gets into the brain that's not going to happen the liv

er is only going to convert a small amount of it um so you're not really entering that much into brain Beyond just the basic amounts if you really want to put a whole lot of it into the brain to heal the brain it needs to be in a phospholipid-bound state krill oil is naturally bound to phosphatidyls choline and it naturally directly enters the brain this is the actual chemical thing that shows that it enters and this is the this one right here is the scientific data that shows that yes in fact i

t doesn't enter the brain unless it's phospholipid bound so but the problem so why don't necess take krill well the krill oil the dosing is not enough for the heart for heart you really need to throw in extremely high dosing and to put enough Krill in for heart health um it would be extremely expensive so I had my son on a common brand of fish oil and on a common brand of krill oil and he took both of those together for whole body health and for brain health and then just recently we put the two

of them together in Omega needs um now what about phosphatidylserine because phosphatidylserine is in a is in a brand that was taken off the market by the FDA because they chemically bound it to the to the um Omega-3s and you can't do that that makes it's a drug if you chemically bind it but so there is no phosphatidylserine product Omega-3s that's available in the United States um but phosphatidylserine naturally occurs no chemical conversions necessary in um in sunflower seed so I took to mak

e this I took Krill and fish oil put together so you have lots for the heart phospholipids for the brain and I threw in sunflower seed oil on phosphatidylserine that's also good for the brain so this product has all three of them here so those are the products that I recommend for people with significant neurodevelopmental disease via the autism with or without ADHD severe ADHD epilepsy Etc um for Behavioral issues on top of that a lot of behavior occurs at the synapse the synapses where you kno

w the two neurons don't really completely meet there's this little Gap here the neurotransmitters are released and go to the next neuron and so the neurotransmission or is where the neurons connect is really important and one of the things you see in particularly in in younger people like children teenagers Etc is there the balance between the excitatory neurotransmitter so it's a neurotransmitter that's turn on the next cell first this inhibitory neural transmission neurotransmitters that turn

off the neck cell that this balance is off and they have too much excitation they either have a mutation which increases excitation or they have a mutation which decreases inhibition or both and this is very very common in epilepsy migraine ADHD anxiety and autism I see these mutations very frequently and so what a lot of the the doctors will do in is to say okay let's give supplements that decrease neuro excitation and increase inhibition and so that mostly gives antagonists to decrease glutama

te that's the main turn on the next neuron excitatory and things that increase Gaba that's the main inhibitory turn it off neurotransmitter so we're looking for what will turn off glutamate and what will turn on Gaba Gaba is a really key inhibitory neurotransmitter and the Gaba inner neurons or the tiny little Gaba neurons that connect other nerves together are very very sensitive to mitochondrial dysfunction and if you have mitochondrial dysfunction there's some of the first ones to go off so h

ow does energy metabolism cause an excitation you think oh they have no energy right the nerves are going to be decreased no because the nerves that turn off the nervous system are preferentially affected they need more energy that doesn't make any sense until you think about the cookie jar metaphor two-year-old says I want a cookie mom nope I want a cookie now come on cookie no cookie no cookie okay that cookie is gone okay the inhibition has to be constant these little Gabby inner nons have to

constantly be saying no or the excitatory neurons will get their way they use a lot of energy by constantly firing no no no no no no no no all the time so an energy deficiency these go first and the nervous system goes into excitation so what can you do to increase excitation decrease inhibition and that's a big problem in ADHD you can increase Gaba to increase Gaba you can give Gaba you can give l-theanine that's caffeine is what people think about you know how does coffee and tea affect you b

ut these soothing aspects of tea is the l-theanine it doesn't sedate you but it soothes you and it does this in large amount by boosting Gaba um 5-HTP also works on similar but it also works on serotonin that's another inhibitory pathway and then the B6 and magnesium are help these so I was often recommending that my patients go over the counter and get all of these I put them in calm needs but this is something if it works it works if it doesn't it doesn't this is sort of like you take like Mot

rin if you don't feel better on the Motrin why take it again this is something not to make the disease better over months which is what you're doing with the fish oil the Coq and the miter cocktail but what can you do to increase the behavior today Okay so standing back to the whole thing um so how do you treat it what's a holistic approach um diet natural antioxidants blueberries and Etc will help exercise frequent and in moderation getting good sleep avoiding bad things that's just general lif

estyle I said that you really kind of need that to get good health before you can really attack disease you need to be in a better State um supplements multiple supplements to hit different parts not just one supplement High dosing bioavailable it means it actually gets from the intestines and doesn't go out in the toilet it gets into the brain activated forms so they go directly to the enzymes or wherever they're needed medications I'm sometimes medications are needed ADHD is a serious disease

stimulants are sometimes needed or ssris like I'm Prozac um Zoloft snri like Duloxetine are sometimes very helpful and then that's not taking away um I almost always recommend some degree of counseling for my patients but it's not counseling like sit down on the couch and how did your mother make you crazy to do this no it's not like that it's counseling says okay you have this disease and how can we how can we change your life so that the disease is better off and how can you change it and how

can you look at your life in ways that makes it meaningful for you um what can you do to look at this from a different perspective is is to try to make as much as you can with your life despite your issues that you have that maybe you know they may be some obstacles but they're not going to stop you they just may make you have to find ways around it and then of course I'm finding the appropriate accommodations for education and testing it's also very important and that sometimes helps if you hav

e a genetic diagnosis because you're not just any hyperactive kid now you're a kid with a known diagnosis and the teachers take it more seriously not that they should take it more seriously it's the same kid but you know we don't live in a perfect world so um my recommendations um high-powered mitochondrial cocktail um neuro needs does make it but there are some other companies that make it and have already told you about one of the um of the other brands um the dose is recommended based on the

patient's weight they're generally on the labels I do check blood doses of carnitine and vitamin D 25 hydroxy vitamin D make sure they're high enough these mitochondrial cocktails do not have Coq or they don't have enough Coq the blood level doesn't go high enough the oil does not mix in the powders it's got to be added separately I check blood levels it's got to be ubiquinol the essential fatty acids same thing the oils do not mix in the powders um krill oil is best for brain health goes direct

ly to the brain but fish oil is also really good for the rest of the body and I would say you know for brain health alone krill oil but for considering General Health and everything think about using separate supplements or a supplement that combines them together such as the Omega needs that we sell um and so this is sort of a Basics these three are the main Basics so your high-powered mitochondrial cocktail your Coq your essential fatty acids but everybody's different and every and everybody t

here's going to be a different there's going to be a different perfect treatment some people will need more different things um depending upon if they have really bad migraine I usually give riboflavin or B2 they have really bad constipation I'll give magnesium citrate Etc or based upon the a blood level or based upon a on the genetic so you really need to have this in this patient because this is where the problem is um if there's a lot of anxiety hyperactivity or insomnia consider um changing

the neurotransmitter balance and the easiest that the least to have the least side effects the safest way to do that is to use over-the-counter supplements com needs is one way to do it there are also medications beyond that can do that understand that diet and supplements are both necessary and synergistic there are things in blueberries that you cannot buy in a supplement but there are more but a supplement you could eat all the blueberries in the entire grocery store and the supplement will h

ave more of some things they're really they're both good diet and supplements one does not make up for the other you need both of them they're synergistic don't um next bullet point do not neglect your lifestyle in general you need to do the right things and avoid the wrong things um medication dietary supplements are not necessarily instead of medication but in addition to are there people that the medication that the supplements are all that you need oh definitely I've seen many of them that t

hey don't need medication on the supplements or adhds under control but there are many others that need some medication as well this is a serious disease everything from having children too early to smoking to you know it's to um car accidents I mean you name it I mean this is an issue it needs to be treated and again these are General recommendations they're not meant to circumvent or contradict your Physician's advice everything that you do supplements medication everything should be in coordi

nation and discussion with your physician and these are just general ideas to think about and discuss with your Physicians so and then here this is pretty much the same thing as before just look um so some of you might be saying well you just came out with this product Focus needs and you didn't say anything about it at all that's true Focus needs is a different type of product I mean the people that generally take the products that we've been talking about um are generally people that have sign

ificant diseases um and that really want the best treatment and it but it there is a cost to that and it may not be appropriate necessarily to give all of those treatments to somebody who just has very mild ADHD and nothing else and many times parents will say well you know his sister she's got some inattention in hyperactivity we don't know you know if he meets diagnostic criteria but is there anything like that you can do what would you do I don't want to give her all of this different stuff i

t's too expensive and I really you know it's a lot of time and effort and everything but it's just one product that you can give on that and so I thought about that and said well I want to be able to reach more people than we are reaching now and people and that maybe don't have the budget to for these other products or maybe their kid just doesn't need as much and also you know just anybody including adults college students or whatever that just want to boost their focus they don't have a disea

se that they just want to take things that will naturally increase their focus and so it came up with Focus needs Focus needs is a box that contains two different things because the the the um the vitamins that come in the in powders do not mix with the oil again it's a general physical problem so so there are two things in here this has the oil and this is the same as the mega needs really and this has the vitamin stuff and what vitamins in it the acetyl carnitine the B2 riboflavin B6 B9 which

is folate B12 vitamin D magnesium zinc and l-theanine the ones that I showed you that are important in ADHD and then here I've already talked about Omega needs it has the the fish oil the krill oil the phosphatidylserine I didn't mention the sampton that's a very important antioxidant that comes in the Krill it's it's why flamingos are are pink or red because they eat the Krill and the shrimp that are red and why are they red they are red because of this chemical here astrazanthin so if you ever

wondered why flamingos are pink that's it and and oh and the capsules are red by the way so this is one product sort of thing for people that are have minors so lesser problems so this is significant neurodevelopmental issues autism very bad ADHD um autism with ADHD epilepsy you know these sort of things um choose your mitochondrial cocktail if you can swallow I recommend energy needs if you can't swallow the lemon or Berry flavored one of these plus Coq plus Omega um but you know for for Price

or for ease the focus or something like that you just you want one product it comes in two different bottles but one box should do it if you want more information about this particular like what is the data behind all this my website I um wrote everything on it neuroneedes.com um if you go to the conditions at the top and go ADHD you can find many many things there but this is one of them you can click on any of these and it'll tell you exactly what the data is behind any of that this is how yo

u can get there directly there's a lot of other information there and if you're interested in the DNA testing to find out exactly why you or your child has it um speak to Lori my coordinator and here it is neurogenomics and neurobilities.com I did not come up with this name of the company there's no o in your abilities it's not neuro abilities the O is missing people always type that in wrong again this is going to be available on the site so you can find the um these direct links and thank you

very much and I've gone over but I hope that I give a lot of information that can be helpful and remember next in next month we'll have a question and answer and we'll also have a physician in to really kind of discuss in a conversation less intense on on this sort of stuff so it might be more easy to understand and certainly if you have questions then go ahead