With somewhere between 1 in 15 and 1 in 30 children now having an ADHD diagnosis, we would hope that better therapies would be available to prevent the disruption in achievement, well-being, and relationships. This review of the state of ADHD genetics answers some of those ‘Why?’ questions, the question which explain our current approach to ADHD both conventionally and in functional medicine. It also points towards needed future research. In short, looking at the interaction between numerous genes affecting multiple neurotransmitter pathways in multiple brain regions, all cross-reacting with multiple environmental factors, we don’t have just one ADHD. Like with autism, we have multiple types of ADHD which respond to different therapies differently.
The Challenges of the ADHD Life
For these children and their families, the behavioral symptoms make so much of life into a challenge: in school, in the family, in other relationships, and more. Beyond these day-to-day disruptions, though, we know that ADHD diagnoses demonstrate a higher co-morbidity and mortality risks. Children in the conventional system get switched from one medication to another until something clicks. Many do get some relief from these meds, but even then, the drugs can be side-effects, some obvious, some not so obvious. This paper offers some explanations why the medications work differently for different children.
The Complexity of ADHD
Early in the focus article, the researchers paint a picture of why this diagnosis is so complex and why therapy is so challenging. First, multiple neurotransmitters in multiple areas of the brain interact to produce the symptoms we call ADHD. Second, various micronutrients affect the production of these neurotransmitters. Third, environmental factors including toxins influence ADHD occurrence.
They came to these conclusions by completing a systematic review of the literature on ADHD rather than by doing clinical research on their own. They wanted to bring together into one article a synthesis of what is known about ADHD genetics, as they relate to mechanisms and current therapies.
The Findings
The literature review identified 30 different genes which were involved in potential ADHD pathogenesis, either in animal models or in human studies. These genes were mostly connected to the dopamine neurotransmitter pathway, but they also related to other neurotransmitters and certain metabolic pathways like methylation and acetylation. The researchers noted that due to certain animals completely lacking various genes, some results could not be transferred directly to humans. While this leaves more questions than answers, we can take away a few points from this article.
Takeaways
First, different people will respond differently to different therapies and medications. Each therapy, whether a natural option or a manufactured medicine, will affect different pathways in different parts of the brain in different ways. Each individual person with ADHD has a different genetic interference or a different environmental factor than the next person with an ADHD diagnosis, and so some individuals will react very differently to a given therapy. This fact goes for many other medical conditions, like mast cell activation. Not everyone will benefit from the same therapy.
Second, many will have more than one pathway or more than one brain region affected. They may not find relief from only one therapy. Sometimes healing will require both the therapy and a change in environment, not just the therapy. Again, we see a need to individualize our approaches.
Third, we should integrate rather than separate conventional and natural options. We see many in our clinic whose ADHD symptoms improve with nutritional therapy or detox therapies or anti-inflammatories (in our PANS/PANDAS patients). Jumping straight to pharmaceuticals is unnecessary, but they can be useful later in the treatment plan.
Proven Environmental and Nutritional Factors
The literature review pointed to prior research connecting reversible factors like nutrition and toxins to ADHD risks. While we can’t change someone’s genetics, we can improve nutrition and decrease triggers for these symptoms of ADHD. On one hand, studies show that children with ADHD have lower levels of iron, copper, zinc, magnesium and Omega 3’s (Sinn and Bryan, 2007; Verlaet et al., 2014). This correlation does not prove causation, but it does beg for more research, as these nutrients are known to play a role in neurotransmitter function. On the other hand, research has connected certain dietary factors to increased ADHD symptoms—things like sugar, artificial colors, and preservatives (Holtkamp et al., 2004; Cormier and Elder, 2007; Mahmoud et al., 2011; San Mauro Martín et al., 2018). Mercury and manganese were also found to be related to ADHD symptoms (Yoshimasu et al., 2014; Banerjee et al., 2007; Boucher et al., 2012). And don’t forget lead (Foltinová et al., 2007; Lanphear et al., 2005; Nevin et al., 2008; Boucher et al., 2012; Goodlad et al., 2013).
Treatments
While the researchers claim an 80% success rate using medications, they do appreciate the potential for nutritional restrictions and dietary removals of those things noted above. They even cite studies with various special diets as having some potential for benefit, though they say controversy still exists there.
What We Can Learn
Similar to Autism, when we see one ADHD, we have to remember: the next child’s ADHD will probably be different in some way. From a chemical mechanism and genetic standpoint, differences abound. We haven’t even touched on the different psychosocial dynamics each child presents: their symptoms affect them and their family differently from the next patient.
Helping our pediatric patients thrive in spite of the ADHD label means we go beyond a series of prescription med trials until we get something to work. It means we take the time to understand that one person sitting across from us, considering both their individual chemistry (including carefully chosen tests) and their whole life experience. We tailor our testing and therapies to their needs. This process includes a series of trials to see which nutrients need to be added, which brain irritants need removing, and then which nutraceuticals can benefit brain chemistry, all while we work to remove any identifiable and modifiable root causes.
This approach leads to healthier, more abundant lives with less need for medications and more enjoyment of childhood and family life.
Other SFM Articles on ADHD:
Original Article:
Kessi M, Duan H, Xiong J, Chen B, He F, Yang L, Ma Y, Bamgbade OA, Peng J and Yin F (2022) Attention-deficit/hyperactive disorder updates. Front. Mol. Neurosci. 15:925049. doi: 10.3389/fnmol.2022.925049
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.
Dr. Eric Potter graduated from Vanderbilt Medical School and then went on to specialize in internal medicine (adult) and pediatric care, spending significant time and effort in growing his medical understanding while caring for patients from all walks of life.
