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The NICE Report mentions only nervousness and sleeplessness as common side-effects, and that other effects reported have been "relatively minor". Despite the general acceptance by the US and UK psychiatric community to medicate this highly controversial disorder, there are now signs that the debate has reached a turning point with the launch of various legal actions in the US against not only Novartis but also the American Psychiatric Association for alleged fraud and corruption (see box, previous page), with similar actions apparently pending in the UK. Now might seem an appropriate time for many MPH advocates to pause and consider non-drug treatments, specifically the growing evidence for the efficacy of nutritional and heavy metal detoxification treatments. The NICE Report mentions only nervousness and sleeplessness The absolutely essential fatty acids that cannot be synthesised as common side-effects, and that other effects reported have been by the body and therefore must be supplied in the diet are linoleic "relatively minor". acid (n-6 series, to which DGLA and AA belong) and alpha- Despite the general acceptance by the US and UK psychiatric linolenic acid (n-3 series, to which EPA and DHA belong). Both community to medicate this highly controversial disorder, there AA and DHA are termed "longer-chain polyunsaturated fatty are now signs that the debate has reached a turning point with the acids" (LC-PUFAs) and can usually be synthesised from their launch of various legal actions in the US against not only Novartis EFA precursors. The latter are critically important as precursors but also the American Psychiatric Association for alleged fraud of a complex group of highly biologically active compounds and corruption (see box, previous page), with similar actions including prostanoids (prostaglandins, thromboxanes and prosta- apparently pending in the UK. cyclins among others) and leucotrienes. These compounds per- Now might seem an appropriate time for many MPH advocates form numerous regulatory functions in the brain and the rest of to pause and consider non-drug treatments, specifically the the body. growing evidence for the efficacy of nutritional and heavy metal Dr Alexandra Richardson (Physiology Lab, Oxford) and B. K. detoxification treatments. Puri (MRI Unit, Imperial College, London), in their important paper summarising the evidence ("The potential role of fatty acids NUTRITIONAL APPROACHES AND INVESTIGATIONS in attention deficit/hyperactivity disorder", PLEFA 2000;63(1- Essential fatty acid deficiency 2):79-87), state: Twenty years ago, Sally Bunday and her "EFA metabolism can influence many mother, Irene Colquhoun, founders of the aspects of brain development, including neu- Hyperactive Children's Support Group ronal migration, axonal and dendritic (HACSG) in the UK, were the first to pro- growth, and the creation, remodelling and pose that essential fatty acid (EFA) deficien- pruning of synaptic connections [Crawford, ° queht A nee a One Surveying a group of MA in pazan. NG. e Neurobiology of ., Bunday, S., Med. Hypotheses 37:673- . . ssential Fatty Acids, Plenum, ; 9). Surveying a eroup of hyperactive chil- hyperactive children, 1992:307-14]. dren, they found an excess of males, a link they found an excess Animal studies have shown that both with asthma, eczema and other allergic con- . . neural integrity and function can be perma- ditions, and evidence from hair analysis of of males, a link with nently disrupted by deficits of n-6 and n-3 zinc deficiency. Clinical signs, such as asthma, eczema fatty acids during foetal and neonatal devel- excessive thirst, frequent urination, dry skin and dry hair, were observed that are consistent with EFA deficiency. In the United States, a diet developed by the late paediatrician Dr Benjamin Feingold (Am. J. Nursing 1975;75:797- 803; Why Your Child is Hyperactive, Random, NY, 1975) was designed to eliminate certain synthetic additives and some foods, especially fruits, con- taining natural salicylates, which inhibit the conversion of long-chain polyunsat- urated fatty acids to prostaglandins (see below). It was very successful in reducing symptoms, and groups sprang Research by M. Makrides and co- up all across the US and remain active workers has shown that infants may in promoting and researching his treatment. In the UK, groups benefit considerably from the LC-PUFAs naturally present in opment [Yamamoto, N. et al., J. Lipid Res. 1987;28:144-51; Neuringer, M. et al., Ann. Rev. Nutr. 1988;8:517-41; Bourre J.-M. et al., J. Nutr. 1989;119:1880- 91). "While both n-6 and n-3 fatty acids are required, the n-3 fatty acids such as DHA appear to play a special role in highly active sites such as synapses and photoreceptors, and deficiencies have particularly been linked to visual and cognitive deficits [Neuringer, N. et al., J. Pediatr. 1994;125:S39-47; Proc. Natl Acad. Sci. USA 1986;83:4021-5]." and other allergic conditions, and evidence from hair analysis of zinc deficiency. also started and the HACSG has adapted the diet for its own use. breast milk but which are absent from many formula feeds Considerable evidence is accumulating that deficiencies in the (Lancet 1995;345;1463-8). body's reserve or production of EFAs is a major contributory fac- Although adequate supplies of EFAs are necessary throughout tor in a range of interrelated childhood disorders, including development and adult life to maintain normal function—and may ADHD, dyslexia, asthma, allergies and even autism, and that sup- be available—it is the conversion of the primary linoleic acid and plementation is valuable in a significant number of cases alpha-linolenic acid into their LC-PUFA derivatives that is crucial (Richardson, A.J., Ross, M.A., Prostaglandins, Leucotrienes and for proper brain function. Unfortunately, a number of factors can Essential Fatty Acids 2000;63(1-2):1-9). The clinical overlap interfere with the conversion of these parent EFAs to their respec- between ADHD and, for example, dyslexia is around 30-50% in tive LC-PUFAs, including: both directions. * saturated or hydrogenated fats Fatty acids play an essential role in brain structure and function. * deficiency of vitamin and/or mineral co-factors (especially Two of them, arachidonic acid (AA) and docosahexanoic acid zinc deficiency) (DHA), play a major role in the brain and eye, constituting 20% * excessive alcohol of the dry weight of the brain and over 30% of the retina. Two * stress hormones others, eicosapentaenoic acid (EPA) and dihomogamma linolenic * diabetes, eczema, asthma or other allergic conditions. acid (DGLA), are crucial for normal brain development but play a Thus, even if the diet contains sufficient EFAs, the child or more minor, structural role. adult may not receive adequate LC-PUFAs due to deficiencies in Surveying a group of hyperactive children, they found an excess of males, a link with asthma, eczema and other allergic conditions, and analysis of zinc deficiency. NEXUS = 21 evidence from hair OCTOBER — NOVEMBER 2001 www.nexusmagazine.com