Understanding ADHD and the role of the Naturopath

Our practitioners recently attended a day-long seminar focussing on ADHD. This is a presentation that we are seeing so much more commonly now in clinic, and we particularly have noticed a sudden rise in Adults presenting with Late-Diagnosed ADHD. ADHD has previously been thought of as a childhood condition, however awareness around adult ADHD is growing. So how can a naturopath support ADHD?

By Caryn Levick ND

What Is ADHD?

Attention deficit hyperactivity disorder (ADHD) is currently classified as a neurodevelopmental disorder that is characterised by symptoms such as inattention, hyperactivity, and impulsivity. Despite its prevalence, ADHD remains widely misunderstood, and individuals often face stigma and discrimination. ADHD is known to significantly affect an individual’s daily functioning, social interactions, and overall quality of life, yet diagnosis is often missed, especially in adult women, with individuals labelled as “anxious or depressed”, “burnt out”, or even “just lazy”.

Traditionally, ADHD has been viewed as a deficit or a disorder, with a focus on correcting behaviours to fit in with neurotypical expectations. However, a growing body of research suggests that ADHD is better understood as a difference in cognitive functioning, rather than a pathology. As such, there has been a shift towards neurodiversity affirming approaches to managing ADHD in both children and adults. These approaches prioritise a person-centered approach, which recognises and celebrates the unique strengths, challenges, and perspectives of individuals with ADHD, rather than their deficits. 

How is the ADHD brain different?

1. The default mode network (DMN), are a group of interconnected brain structures associated with mind-wandering, task-irrelevant mental processes and ruminations, and shows high activity during periods of rest or when engaged in internal tasks such as daydreaming.  The DMN becomes deactivated when moving to external or goal oriented tasks.

Functional MRI scans show that patients with ADHD have disconnection or inverse activity of the DMN leading to attention lapses and mind wandering which intrudes on normal functioning.

2. Differences in dopamine production, transmission, and availability. Dopamine is essential in our drive system. It’s the ‘reward’ brain chemical. It motivates us to action and behaviour. It is involved in executive functioning networks and self-regulatory networks. ADHDers show differences in motivation and in reward response, and this is driven by differences in dopamine production, transmission, and availability.

These differences often impact our Executive functioning – our executive functioning skills are like the brain’s admin. Roles include holding onto information, organising planning, delegating coordinating, and doing so quickly and efficiently. In an ADHD brain, the executive functioning systems are under-resourced. ADHD can significantly impact several key executive functioning skills, including:

1. Working memory – Maintaining and manipulating information in short-term memory can be challenging. This can affect tasks that require following multi-step instructions or solving problems.
2. Inhibitory control – Individuals with ADHD may struggle with inhibiting impulsive behaviours or responses. They might blurt out answers or act without thinking.
3. Attentional regulation – Sustaining attention on tasks that are not inherently interesting can be difficult. Individuals with ADHD may become easily distracted by external stimuli.
4. Task Initiation – Starting tasks, particularly those perceived as boring or challenging, can be a hurdle. Procrastination is common.
5. Organization and Planning – Managing time, setting goals, and breaking tasks into smaller steps can be problematic. Individuals with ADHD may struggle to complete projects or meet deadlines.
6. Emotional Regulation: Managing emotions and frustration can be challenging. Mood swings and emotional outbursts may occur.

How Can A Naturopath Support ADHD?

ADHD is a complex condition, the differences and severity of symptoms can vary among individuals. ADHD is influenced by both genetic and environmental factors. Treatment often includes behavioural therapy, medication, and tailored strategies to help individuals manage their symptoms effectively. BUT WE, as Naturopaths and Clinical Nutritionists HAVE SO MANY TOOLS to assist with altering the environmental factors, to optimise brain function, increase capacity and ultimately help with the symptoms of ADHD!

Conditions That May Influence ADHD AND That Respond Well To Natural Treatment:

1. Nutritional deficiencies: ADHD is associated with a wide range of nutritional deficiencies, including vitamin B6, folate, vitamin B12, iron, and omega-3 fatty acids. Insufficient levels of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and vitamin D have been linked to dysfunctional serotonin activation in the brain, which is a key regulator of dopamine activity.  Iron deficiency can cause changes in neurotransmitter homeostasis, decrease myelin production, impair synaptogenesis, and lower basal ganglia activity, which is associated with reduced cognitive function and impaired psychomotor development. Low levels of vitamin B6, B12 and folate have been observed in ADHD children and shown to be correlated with reduced cognition function and intelligence.

2. Pyroluria (Pyrrole disorder): A common feature of many behavioural disorders is pyroluria which is caused by either over-production of hydroxyhemopyrrolin-2-one (HPL) during haemoglobin synthesis, or by the increased oxidative degradation of haemoglobin. HPL exhibits its effect by sequestering vitamin B6 (pyridoxine) and Zinc in situ, thus facilitating elimination of these nutrients by urinary excretion. Elevated urinary pyrrole levels are found in Down syndrome (70%), Schizophrenia (up to 70%), autism (50%) and ADHD (30%).

3. Gastrointestinal dysfunction: A low level of species diversity in the microbiome may result in gut dysbiosis and impair the integrity of intestinal epithelia, resulting in the movement of inflammatory toxins and pathogenic microbes into the systemic circulation. This in turn can increase  blood-brain barrier (BBB) permeability, which can lead to brain inflammation and behavioural impairments. Research indicates that ADHD patients are at a greater risk of intestinal permeability (IP), which therefore may increase the incidence of immune reactivity against food proteins (such as gluten), triggering systemic inflammation and neuroinflammation. Moreover, ADHD patients may also present with coeliac disease, or non-coeliac gluten sensitivity (NCGS), which may manifest without gastrointestinal symptoms, however is associated with mucosal inflammation, IP, and immune reactivity. 

4. Circadian rhythm/sleep disruption: Bedtime resistance, delayed sleep onset, decreased sleep duration, night awakenings, daytime sleepiness and disturbed circadian rhythms are prevalent in ADHD. These effects have been associated with reduced melatonin synthesis, which is endogenously synthesised from serotonin, which has been reported to be low in ADHD patients. Sleep disruption may also be influenced by stimulant medications used to treat ADHD, alongside comorbidities, such as internalised anxiety, obstructive sleep apnoea, and external environmental factors, such as psychological stimulation based on media content, blue light emitted from devices, and electromagnetic field (EMF) exposure.  Sleep deprivation is a physiological stressor often associated with increased cortisol levels, and may exacerbate ADHD presentations and the risk of developing comorbidities.

5. HPA axis dysfunction: Unique stressors encountered by ADHD patients (such as parental stress related to their condition, psychosocial stress, such as bullying, or increased physiological stress caused by sleep deprivation) may predispose individuals with ADHD to dysfunctional HPA axis response (characterised by a reduced CAR test). Dysfunction within the HPA axis is associated with greater ADHD severity marked by the presence of ADHD behavioural comorbidities (e.g. oppositional defiant disorder [ODD]).

6. Impaired methylation: Variations in DNA methylation have been linked to functional deficits in ADHD, particularly in genes related to dopaminergic and neurotrophic systems associated with response control behaviour. Reduced levels of key methylation nutrients, such as vitamin B6, folate and vitamin B12 have been observed in ADHD patients, suggesting that ADHD pathophysiology may be influenced by methylation efficiency. Moreover, genetic variants in enzymes involved in folate metabolism that predispose individuals to hyperhomocysteinemia have the potential in influence ADHD-associated behaviours.

7. Environmental toxin accumulation: Higher levels of heavy metals such as lead, antimony and cadmium, alongside exposure to bisphenol A (BPA), and persistent organic pollutants (POPs), phthalates and glyphosate can drive systemic inflammation, neuroinflammation and impair neurodevelopment in ADHD.

8. Chronic inflammation: Impaired anti-inflammatory mechanisms (i.e. omega-3:6 ratio) combined with increased inflammatory responses (as a result of various factors, such as brain injury and atopic immune activation) mediated by cytokines such as interleukin-6 (IL-6) are associated with inhibiting neurogenesis, which may limit neural growth and development and increase the risk of ADHD severity. Inflammatory damage caused by exposure to oxidative stress (e.g. increased nitric oxide free radicals from cigarette smoke) may cause further damage to the Blood Brain Barrier, and activate T cells in brain tissue, resulting in further activation of pro-inflammatory cytokines and neurodegeneration, that may drive ADHD pathophysiology. Research indicates that children with ADHD have higher levels of inflammatory cytokines.

9. Blood sugar issues: Fluctuations in blood glucose control evidenced by increased haemoglobin glycation (signifying patterns of hyperglycaemia) have been observed in ADHD, which may negatively influence behavioural manifestations of hyperactivity. Moreover, conventional ADHD treatment has also been associated with hyperglycaemia.

10. Hormone imbalances: An example of this is low oestrogen. Our brains love oestrogen – it is neuroprotective, improves cognitive function, modulates acetylcholine (memory) and serotonin (mood), and it enhances the activity of dopamine. Therefore it makes sense for us to take into consideration an ADHDers hormone levels. Research suggests:
    1. Premenstrual symptoms may be worse in ADHDers. 
    2. Postpartum and breastfeeding women are more likely to present with a deterioration of ADHD symptoms and an increase in depression – this is when executive function is really being tested! 
    3. Perimenopause – ADHD symptoms become more severe as oestrogen declines. Oestrogen decline is associated with cognitive impairment, brain fog, memory issues and mood disorders, just to name a few.

A naturopath’s approach to managing ADHD focuses on managing symptoms and comorbidities, while addressing possible underlying drivers, such as neuro-inflammation, diet and nutrient imbalances, gut-brain axis dysfunction and hormonal irregularities. An integrative approach may also focus on reducing side effects of medication or managing their long term consequences. 

This seminar gave us strategies to implement into our clinical practice, ensuring a person-centred approach to care that embraces neurodiversity and recognises the unique strengths, challenges, and perspectives of individuals with ADHD. And we are so excited to be able to continue to share our knowledge with you. We are here to treat the WHOLE person!

The good news is… with appropriate interventions such as behavioural therapy, medication, nutrition, exercise and tailored strategies, individuals with ADHD can learn to manage these difficulties and lead successful lives.

Book an appointment online with one of our practitioners or call our clinic on 07 3075 7090.