- To Change Your Mind - Details Matter
ADHD: Vyvanse and Duration – DOE Simplified
Stress and Sleep: Neurotransmitter Secrets on CorePsych Radio
June 8, 2009ADHD: Vyvanse – The Therapeutic Window Mystery
June 11, 2009DOE = Duration of Effectiveness, An Essential Tool
This brief video requires your immediate attention: The ADHD medication mess can be significantly corrected by regularly paying attention to the specifics of each individual DOE, – is it too much, or too little? Basic!
Do we really have to pay attention to treating paying attention? Oh yeah…
DOE is the acronym that absolutely should be on every medication progress note with every stimulant medication, period. Why am I so dogmatic? Take a look at this video and see what you think about the value of this kind of precise thinking.
DOE would cut out all this flap about what's wrong about psych meds and much of the noise about side effects. It's a simple matter of respecting, paying attention to the basic science of:
- The medication delivery process [how it is made by the company to be released in the body] will set the hours of DOE for each product if the dosage is adjusted for best DOE effect [less is too little, more is too much]
- Immediate Release [IR], [Ritalin IR-4Hr, Dexedrine IR-5Hr, Adderall IR-6Hr]
- Extended Release [Adderall-XR -10/12hr, Ritalin LA -8Hr, Concerta 8-10Hr, , Metadate CD -8Hr],
- Daytrana Patch 10-12 Hr, or
- [in a separate DOE league]: Vyvanse – the benefit: 12-14 Hr, by peer-reviewed findings and in my office.
2. The metabolic individuality of that specific person will set the individuality of that metabolic process-
- Determined by genetics [CYP 450], CYP 2D6 has multiple genetic variations see this CorePsych post – 4 most measurable
- liver function and drug interactions – see this previous CorePsych post,
- inflammation
- nutrition
- bowel function [fast or slow transit],
- metabolic disorders,
- immune dysregulation
Each one of these variables can effect DOE, and the more challenged the liver, the more metabolic problems, the narrower the window, the greater the difficulty finding the right dose. I will send out a specific video on the Narrow Therapeutic Window soon – stay tuned. [You can subscribe to my YouTube Channel [to stay informed via email.]
Or sign up for the blog email updates here if not already hooked up.
Drop a comment to let me know if this DOE video note is useful for you and yours.
Think DOE! And check out Rules below for more details on exactly how and why DOE.
cp
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31 Comments
Hi!
I find your website and your vids very helpful in educating myself to know how to best manage my meds.
I am on Elvanse and have titrated very carefully and I am on 70mg, it lasts me about 8 hours then I crash. Higher doses makes me tired moody and jittery 4 hours after taking it, lower dose works good but with shorter doe.
This gets me through workday but makes me a horrible dad in the evening:(
Don’t think I have digestive problems but I have low Testosterone and am on TRT, one other thing is that antihistamines puts me right to sleep. Could you please point me in a direction for me to further investigate on how to have longer DOE ?
Sincerely
Patrik
Patrik,
The fact that it lasts 8 hrs and any increase creates problems leaves me with the strong impression that you likely suffer with a Narrow Therapeutic Window.
1. Search on this site for that term – then see my Therapeutic Window video on YouTube for more explanations.
2. Check out this video series to instruct for the possibility of comorbid energy or serotonin challenges – link: http://corepsych.com/drop
3. Consider asking your doc for an immediate release lower dose for the PM as one would with any other time release stimulant – explained in the /drop series.
4. Do consider a serotonin issue – even though you may not feel depressed. In my book [hint: on sale at Amazon Kindle until year end: $.99] I discuss in detail cognitive manifestations of serotonin issues – also see Clint Eastwood here in Gran Torino.
Hope this helps!
cp
Thanks for the quick reply Dr Parker.
I have previously been on ssri and it made me closed of emotionally especially towards my family, that was however before I was diagnosed ADD and therefore not on stimulants then.
I found it hard to come of them and hesitate to start again.
But I really do need to make this work so might give it a go.
Elvanse really does wonders with me when in the sweet spot!
Do you have any experience with Modafinil for add and is it possible to maybe alternate for different purposes and effects?
Again thank you for your time it means a lot to me 🙂
Patrik
Patrik,
The use of those two medications together makes good sense if you don’t have associated metabolic issues that corrupt the process. See this video on how to mix the two: http://corepsych.com/balance
I don’t often use Modafinil for ADHD as it’s not approved by the FDA, but can report that it may have a positive effect. As soon as I start to go off label with medications, thinking of deeper medication alternatives, I always catch myself and look more deeply into comorbid contributory conditions: http://corepsych.com/walsh-resources
Best for the Holidays, – I wish you wellness!
cp
[…] Vyvanse DOE – Duration of Effectiveness Simplified […]
[…] Details on approaching DOE for any stimulant: http://www.corepsychblog.com/2009/06/adhd-vyvanse-and-duration-doe-simplified/ […]
I’ve been on Adderall IR for a while now. Its making me have a sick feeling in my stomach…like queasy or nervous stomach feeling. Please give me some insight. I am in a new area and do not have family dr. yet. Though I continue taking it because it seems to be the lesser of the two evils, i.e., dealing with the symptoms of the ADHD or being sick to my stomach. Come to think of it, the medication is not really helping my overall symptoms but does seem to keep me calmer and gives me more patience, etc.
Years of living with this is taking a major toll on me. I am one of those who attempted suicide (many years ago) and feel so labeled and judged when I see a dr. or go to the pharmacist for refills it makes me want to throw my hands up. No health insurance, but good income so moderately priced is o.k. Just desperate for something. Visit to psych was over $300 so it was not gonna happen. Family dr. is only option right now. I go in prepared and armed with data cause most of them know very little in reality about the disorder.
Pam,
For 10$ and change you can read my New ADHD Med Rules/book at: http://www.bit.ly/rulesbooks pre-pub discount.
For now must absolutely do a protein breakfast, stim meds always work better after that protein breakfast: http://www.corepsychblog.com/2007/02/power-breakfast-recipe-2-how-on-protein/ These detail work – and if they don’t you do need a more careful workup for food sensitivities. http://www.corepsychblog.com/2007/08/celiac-notes-opiate-withdrawal-from-gluten-and-casein/
Best!
cp
Dr. P.
I was anxious this morning to see if I had a reply, tho certainly not expecting one. So thank you kindly for your quick response. I have already purchased the $10 Rules book but haven’t yet figured out where the heck it went or if I even downloaded it correctly. I will try and find it today. Right now I’m trying to figure out whether to take my med this mornign or not. I will do your protein breakfast for sure.
If its gluten, etc., I will change anything to get my meds to be effective. I’m very accustomed to a yo-yo existence. I can’t imagine a food withdrawal being any different or worse than what I’ve already endured. Its soo much better than it ever was, with the medication which is why I HATE to get off it. My depression is almost gone completely so I don’t want to give it up. Incidently, I pick up a new RX today and the pharmacist has referred me to a new family dr. I plan on jotting down the name to make an appt.
My routine is:
1. take med around 8:30 (break 15 mg pill in half)
2. take other half around 12:30 or 1:00. By later afternoon and through the rest of the night, my stomach is churning with discomfort…I can actually “hear” it digesting or whatever it is doing; though I’m confused what it is doing since I’ve hardly eaten anything all day.
The higher the dosage, the higher the discomfort level.
If I were to take the 3rd dosage say mid afternoon I believe, the level of quesiness would subside but I would not be able to sleep, so that is not an option; so I just endure the stomach flips. I’m actually prescribed 3 pills per day, which I was tolerant of at first, but that is no longer the case.
I’m going to try your power breakfast this morning…..and PRAY.
Is your other book available in “e” form? Im confused about which I need . SO thankful I found a professional who is trying to help with this problem
Pam,
Thanks for connecting on the book, the eBook at Amazon is a Kindle edition only, if you get the eBook from my website [ https://store.corepsych.com/ADHD-Medication-Rules-Paying-Attention-To-The-Meds-For-Paying-Attention-170-pages-eBook-by-Dr-Charles-Parker_p_697.html ] – it’s readable in your computer, as a pdf. The paperback is now available at these stores at pre-publication discount will be sent out soon printing underway: http://www.bit.ly/rulesbooks – hope you connect with those New Rules pages, they will support the excellent progress you’re making.
RE the stomach haps: Do try to make sure you take the noonish dose after a protein bar – outlined protein bar options here: http://www.corepsychblog.com/2007/02/power-breakfast-recipe-2-how-on-protein/ – that should significantly stop the gurgle. Immediate release meds on an empty stomach almost always spell GI rebound. Higher dosage = more rebound on that empty stomach. Small details, but they work 90% of the time.
Keep us posted!
cp
If you dont like the way you feel on adderal, tell your doctor you want to stop taking it and he will slowly decrease your dosage until you can safely get off of it. The doctor cant force you do or take something you dont want. If you want to treat your ADD in a safe and healthy way, try changing up your diet and nutrition. Incorporate plenty of healthy fats in your diet because the brain requires certain fats to fully function properly, not to mention its made out of fat. Despite all the hell fat gets from the mainstream media it is one of the most important parts of the brains developmental process. Kids are being forced to drink skim and one percent milk which has practically no fat in it whatsoever and are being handed sugary fruit juices, candy, breakfast cereals, and junk food in place of natural whole milk. And products that claimed to be “sugar free” are just loaded with artificial sweeteners and food coloring that is worse than regular sugar. This is why so many neurological disorders like ADD/ADHD, BPD, depression, and autism are so common today. We are being slowly poisoned by so many different chemicals in our diet just so that products on supermarket shelves, which are practically nutrition-less, will hold a longer shelf life and look more appealing to the consumer. All while making the food companies and big-agra richer and richer while we get sicker and sicker. And thats where big pharma and the doctors step in to sell you their drugs. Dont take every pill the doctor throws at you because they dont treated the underlying cause of your problem they just cover the symptoms. Medicine should be a last resort in emergency situations. Health comes from nutrition and a good state of mind. When you go to the store choose organic dairy, meat, and egg products that aren’t reduced fat. Eat healthy carbohydrates like oatmeal, sweet potatoes, fruit etc… and stay away from processed and refined sugar and grains. Plus make sure you always eat plenty of organic leafy green vegetables such as broccoli, kale, and Brussel sprouts.
Matt,
All good advice – but know that correct medication management and comprehensive testing can preclude many of these problems and resolve treatment failures most of the time. [Nothing’s 100% in medicine!]
cp
Thanks so much Dr. Parker for your website and your blogs! We have an appointment with you in November and it can’t come fast enough! My son, who is 8 years old, is having an extremely difficult time in school. He is currently taking 40mg of Strattera and 1mg of intuniv twice a day. We took him off of Ritalin after his last day of school this year because he was flat, unmotivated, lethargic, not eating, sleeping, etc. His therapist saw him on that medicine and then saw him a week later after we took him off and she said she has never had a patient who was so affected by medication. In fact she had entertained the thought that he might have Asperger’s, but after the Strattera kicked in she immediately threw that thought out! Once he started taking the Strattera at 25 mg, we noticed a huge difference! Our mornings and evenings were smooth – no running around and jumping off the walls, his personality was back, he wanted to try new things (boogey boarding, bike riding etc), he was eating on his own, sleeping, regular in the bathroom, no more bed wetting and just a lot of fun to be around. His impulse behavior was still there, but that we could work with. About two weeks before school started, I noticed his behavior begin to change for the worse. I believe he was feeling anxious about school and rightly so. I think all kids feel that way because they don’t know who will be in their class, and they don’t know their teacher. But for a child with ADHD I imagine it must be a lot harder. We decided to go back to trying a stimulant (5 mg of Focalin 2x/day) before school started to see if that would help. Immediately the same symptoms appeared – flat personality, aggression, lack of appetite, loss of sleep etc. I felt like we had come to far to go back, so we went back to the Strattera. After two weeks of school, he already had a behavior chart that wasn’t working. So, we gave him 5 mg of focalin in the morning with 1 mg of intuniv, another mg of intuniv at lunch and his Strattera in the afternoon. That hasn’t helped at all. So, last visit (10/3/12) at the pediatrician: 3 lbs gained, 1/2 an inch in growth in a month. So we decided to stay with the nonstimulant for now and we upped the dosage to 40mg and kept the intuniv the same. I do believe his metabolism is quite high. He is on day 4 and we have seen no changes at all. We have changed his diet a little – no dyes, no high fructose corn syrup 99% of the time, Omega 3 supplement 2x a day except on the weekends, 5mg of melatonin/day and daily vitamins. He is not a vegetable or fruit eater but does eat protein and rice or pasta (maybe we need gluten free which we have not tried). Is it possible to get a brain scan prior to your appointment at the facility in N Virginia? One more thing. He is in the gifted cluster at school, and they want him to test for the gifted school in our area. He has straight As so far because of his tests. Thanks again for your research and expertise! Hope you can help us help my son!
Nancy,
When you’ve tried so many of the excellent meds and seen little response, the next step is to go deeper with questions and data as you suggest. MY current plan is to save that 3500$ for the SPECT imaging, as there are several other even more precise data points that work effectively once understood. Those test do cost out of pocket money, just as SPECT, but they have a much higher, more precisely predictable outcome, as they are more closely related to actual molecular physiology, rather than a representation of metabolism.
Hang tough, will look forward to seeing you asap, and will know more upon that visit – will be able to tell you exactly the next steps once we understand the functional details.
cp
Thanks! 🙂
Soon!
Here is one example of what happened at an elementary school in Georgia because the principal at the school decided to get serious about what foods they were feeding their students at the school. Now similar programs are beginning to crop up around the country – very slowly, but more and more:
10 years later, school still sugar free and proud
Story Highlights
• Sugar has been banned at Georgia elementary school for a decade
• School required fitness classes, overhauled menu and banned junk food
By Madison Park
(CNN) — The children in the cafeteria drink low-fat milk, shovel corn kernels on their sporks and munch on tuna sandwiches on wheat.
For dessert? Peaches.
There are no bake sales here, no birthday cupcakes, no cookies or ice cream. Don’t even think about bringing sugar to Browns Mill Elementary School.
As schools around the country have begun removing soda and junk food from their premises, the elementary school in Lithonia, Georgia, was ahead of the curve, cutting out sugar 10 years ago under the watch of principal Dr. Yvonne Sanders-Butler.
“Childhood obesity, it’s our tsunami, it’s our Katrina,” she said. “If we’re really thinking about the best interests about the young people today, then we will take a stand.”
Some may think the steps are draconian, but a glimpse inside the school’s cafeteria shows hundreds of students coolly sipping their milk and juice and eating, instead of screaming, squealing and swapping snacks. Soothing jazz music plays in the cafeteria. Watch Dr. Sanders-Butler in the school cafeteria. »
The school day starts with an hour of jumping jacks, exercising and dancing — one morning to the beat of “Whoomp! (There It Is)” as the children bounce and sing along. Students also eat a breakfast of omelets, soy milk, organic cereal and turkey sausages.
“When students are healthy, they do their best work…” Sanders-Butler said. “We want to make sure we’re providing foods that will not only nourish the body, but also brain foods.”
It turns out the kids don’t hate the healthy stuff.
“One of the most requested vegetables now is broccoli…” Sanders-Butler said. “Can you believe that? The kids love broccoli.”
In the first six months of the sugar ban, disciplinary incidents went down 23 percent, counseling referrals decreased 30 percent, and in the first years of standardized test scores, reading scores improved 15 percent, she said. Browns Mill was named a national blue ribbon school and a Georgia school of excellence in 2005.
The school since 1998 has shown improvements in test scores, truancy rates and counselor referrals, said Dr. Terry Huang, the director of obesity research for the National Institute of Child Health and Human Development. More data such as body mass index would be needed to see whether the students became healthier, Huang said.
“We have preliminary evidence showing benefits of the program in terms of the school level indices, but we’re not able to draw definitive cause-and-effect conclusions due to insufficient data,” Huang said.
While the National Institutes of Health is not involved in studying the school, Huang said there is interest; 17 other Georgia schools are replicating the Browns Mill program.
Simone Davis, who was a fifth-grader when the school banned sugar, credits the program with ingraining lifelong lessons about healthy eating.
“I was one of the heavier students in elementary school, so I really lost a lot of weight and just became healthier overall with the changes,” said Davis, who is now a slender junior at Spelman College. “Kids were hyper, bouncing off the wall and those things changed.”
Sanders-Butler overhauled the school’s menu, nutrition program and vending machines after battling her own weight troubles and surviving a stroke at 39. When she sought to eliminate sugar from the school, many resisted and warned her she was endangering her job.
“If we don’t do something, we’re talking about children that are probably going to lose their life at some point. We have to take a stand,” she said.
Schools are now pulling soda from their vending machines and cafeterias. California schools can sell only water, milk and fruit and sports drinks that contain a specified amount of sweeteners. Beverage distributors such as Cadbury Schweppes, Coca-Cola and PepsiCo have agreed to sell only water, unsweetened juice, and flavored and unflavored low-fat and fat-free milk at all elementary and middle schools by the 2009 school year.
What happened in Browns Mill was the result of a number of factors, said Dr. Kenneth Moritsugu, former U.S. Surgeon General, who now chairs the Johnson and Johnson Diabetes Institute. He credits the principal for creating “an environment in her school where it became a normal part of the curriculum to learn about what’s important as far as diet.”
“It really focuses on the children and having the children learn how to make healthy decisions for themselves,” he said. “Second, it created an environment within the schools that encouraged the kids to make those decisions. By having healthier foods, by having physical education, by having vending machines that gives the children the opportunity to make healthy choices.”
Browns Mill fifth-grader Cori Bostic said she would prefer honeydew, watermelon or cantaloupe to cake anyway.
Wincing slightly, the fifth-grader said, “Junk food makes my stomach hurt.”
CNN’s Matt Sloane contributed to this report.
If that is not enough, PLEASE watch this YouTube video with Dr. Lustig, an endocrinologist at UCSF:
This is a 1.5 Hour YouTube presentation by Dr. Lustig of Un of CA, S.F. explaining the dangers of HFCS in our American diet and the reasons why we are experiencing our crisis in being obese and overweight today. WELL worth the time to listen . . . HFCS is WAY beyond being a source of empty calories . . . its a Poison! Listen to him explain why
Robert H. Lustig, MD, UCSF Professor of Pediatrics in the Division of Endocrinology, explores the damage caused by sugary foods. He argues that fructose (too much) and fiber (not enough) appear to be cornerstones of the obesity epidemic through their effects on insulin. Series: UCSF Mini Medical School for the Public [7/2009] [Health and Medicine] [Show ID: 16717]
http://www.youtube.com/watch?v=dBnniua6-oM
Follow this up by reading, Suicide by Sugar, 2009, by Nancy Appleton, Ph. D.
If you would like individualized counseling on how best to improve your dietary habits not only for improved school performance, but for improved overall health, please contact me at nicktompan@gmail.com or call: 757-377-5060
Unfortunately a major threat to our health comes from the very foods we buy at our local grocery stores and from our fast-food restaurants. When you combine eating Frankenfoods while sitting on our keister most of the day, our brains and our bodies are unable to cope with “lifestyle” habits that only lead to what we see taking place within our society today. The mess is our OWN creating, and only WE can undo or prevent the damage IF we get serious about what we put into our bodies. Nick Tompanis, Nutrition Consultant
Well said Nick, thanks for taking the time to share this important info… and here you are right here in Tidewater!
cp
ADHD: Vyvanse and Duration ? DOE Simplified…
I found your entry interesting do I’ve added a Trackback to it on my weblog :)…
Many thanks MD 101!
cp
Dr. Parker,
Clearly many of your patients would benefit from learning what foods need to be eliminated within our typical Standard American Diet that is playing havoc with their health. Even folks that think they are eating a healthy diet, quickly learn that there are so many things that can be changed in order to improve their overall health. As their dietary habits improve there often follows a snowball effect: The better one ate, the better one felt, the better one feeeeeeels (because they have learned how food can be used to control their emotions as well as their cardiovascular, carcinogenic, diabetic and neurological health by eating their way to Happiness!) By changing their eating and lifestyle habits there is NO question that folks will FEEL better than they ever have. The more improvements made in what we eat and how we live, the faster and more dramatic the results will be.
We aren’t meant to be in pain or depressed or not to enjoy the life God has blessed us with. We certainly were never designed to be overweight or obese which often result in the development of many negative health issues. Unfortunately most Americans continue to believe they must “diet” in order to lose weight effectively. I can assure you and your patients dieting is NOT the way to attain one’s desired weight in order to improve other health issues, but improved dietary habits certainly are a must that NONE of us can afford to ignore. The symptoms that our bodies often disclose IS our body talking to us, telling us that we need to change the lifestyle habits that have caused our body to express these symptoms. It is this communication between our body and ourselves that we must listen to, and learn to do something about that will not put us in greater jeopardy. By paying attention to what our body is screaming out to tell us, and by adapting healthy alternative behaviors, many of today’s chronic health issues can be effectively dealt with, so when we see ourselves in our birthday suit, we truly have something to smile about. If I can be of any assistance to you or your patients, please contact me: nicktompan@gmail.com or 757-377-5060
My son is 16 and was recently diagnosed with ADD. He is a very smart guy and this all has been a tough thing for him to accept. He did try Vyvanse and saw some help….but even at 15 or 20 dosage….he was not able to sleep at night. Of course, eventually, that negated all the positive impact of Vyvanse. At first,with Vyvanse, his mood lifted, but over time…he became negative and angry…perhaps just from lack of sleep.
He has been off of all medication over the summer, and I have noticed that when he is hungry at all ( he is 6’5″ and 180 pounds) his moods quickly go very dark and explosive. This seems like more than a normal amount of “hunger pangs”. Essentially….he does best if he eats every 3-4 hours. Could he have blood sugar issues to go along with his sleep issues and ADD?? Thank you.
Denise,
Your guy could have multiple comorbid issues driving this symptom picture, from comorbid depression to incorrect dosage to simply neurotransmitter deficiencies – all are often seen with this kind of presentation and we would have to become much more detailed in our review to sort out the specific causes.
– And yes, blood sugar problems, simple protein and dietary issues could also contribute to this picture –
cp
These symptoms described my 8 year old, who was on Vyvanse when he was 7, precisely! That’s when the pediatrician had us start taking the intuniv. If you are not eating and sleeping, think how you and I feel. It can’t be good for our children to feel like this and have a stimulant in their systems. Its not good for their bodies and this is what makes me feel so helpless and frustrated when trying to help our children!
Nancy,
So true! Take a look at this breakfast post to provide options for breakfast proteins that will very likely help obviate the eating issue: http://www.corepsychblog.com/2007/02/power-breakfast-recipe-2-how-on-protein/
cp
Dr. Parker,
Certainly some medications are very effective for ameliorating the symptoms of AHDH, but what do they do to get to the root of the problem? Basically, nothing, and the individual is often tied to their medication regiments for many years, if not the rest of their life.
As you are well aware, there is a better and more effective way to improve this 20th century disorder. I think we all can agree that what IS becoming quite clear is that what children eat – and don’t eat – plays an enormous part in the ADHD equation. Of course, we can go even further back by discussing prenatal nutrition and it’s role, but let’s not go there at this time. While there are many theories floating out there as to the most effective comprehensive/holistic therapy for ADHD, ALL of today’s children in our society face so many dietary roadblocks that we never faced ever before; hence, children with conditions for which we often find ourselves scratching our heads.
Due to how our processed foods have evolved in this country, the role between AHDH behaviors and food sensitivity/allergies, along with dietary deficiencies of key nutrients should always be considered and explored as they are critical for brain development and appropriate functioning.
A diet that emphasizes protein and complex carbs can have an enormous effect on a child’s behavior. Unfortunately, our society free throws highly processed foods that are loaded with simple sugars, made with white flour, devoid of fiber, and loaded with sodium. This ubiquitous intake of Franken foods as they are now often referred to as, play a KEY role in children’s brain and overall development. These “foods” destabilize glucose/insulin blood levels into surges and crashes that play havoc on the brain’s energy levels as well as the body’s sensitivity to insulin. The brain really rebels when blood sugar levels get too low, and that’s when many folks, ADHD or not, start to feel tired and irritable and unfocused and unable to concentrate, which in itself, sounds a little bit like AHDH. Now think what this same formula of food would do to a child experiencing symptoms of ADHD. By simply eating meals high in fiber and protein which will help slow digestion and level out wild blood sugar spikes and plunges, while totally eliminating highly processed foods, the brain will most certainly experience a more continuous source of energy – glucose – causing it to function better, which could lead to improved behavior. Imagine that!!
Tufts did a study that found the children that ate a good breakfast consisting of old fashioned oatmeal – rich in complex carbs – performed better an hour later on memory tests than kids who ate typical sugary cereals or no breakfast at all.
Of course omega-3s also play a crucial role in brain development and children’s health. Certainly within the typical SAD, children and adults rarely get adequate amounts of omega-3s for normal development, let alone optimal development. So, why would so many more boys exhibit symptoms of ADHD over young girls? Perhaps because their bodies don’t metabolize what they do get in the same manner, leading to a skew in male symptoms. With girls, estrogen helps conserve essential fats, while with boys, testosterone has an opposite effect. Low levels of omega-3s are associated with low levels of dopamine, especially in the part of the brain associated with executive function – controlling impulses and staying on task. Is it that big of a stretch to consider insufficient (high quality) omega-3s may be partially responsible for ADHD children that are moody and anxious?
Vitamin D is now beginning to be recognized for the essential role it too plays in cognitive performance, and our SAD is often crucially deficient in this vital nutrient as well. In a recent study, researchers found that cognitive impairment significantly increased as vitamin D levels declined with senior citizens. In fact, participants with the lowest vitamin D levels had a whopping 2 ¼ times greater risk of cognitive impairment than those with adequate levels. If inadequate vitamin D levels can impair cognitive performance and increase the risk for dementia, again, I must ask, what would inadequate levels do with our children’s brain development? One researcher summed it up this way:
“This is the first large-scale study to identify a relationship between vitamin D and cognitive impairment in later life,” said study coauthor Iain A. Lang, PhD, of Peninsula Medical School in Exeter, England. “Dementia is a growing problem for health services everywhere, and people who have cognitive impairment are at higher risk of going on to develop dementia.” Could we capture the cat’s meow by combining a high quality omega-3 with vitamin D? But why stop there?
Food sensitivities and allergies are also thought to be associated with ADHD behavior. Considering that the human body is composed of some 100 trillion cells, we now also know that 90% of those cells aren’t even our own cells! 90% of the human body is composed of bacteria, with the other remaining 10% human cells. The gut is now being recognized as our second brain that is highly dependent upon its composition of probiotics and pathogens. If there are not enough in number or in variety of strains of probiotics, our second brain, it is being discovered will surely suffer, and will reflect in the development and performance of the brain. Probiotics have multiple functions, one being to maximize nutrient absorption via digestion which also can affect mental performance and clarity. Is there a role for foods containing varied strains of probiotics and supplements providing additional probiotics in the quest for resolving ADHD symptoms and improving child development? The data certainly appears to support it.
There are also vitamins and minerals to consider such as low levels of zinc, iron, magnesium and B6. But perhaps by resolving the child’s digestive issues, these nutritional issues would resolve themselves providing their dietary habits were altered to support whole food, good fat and protein intake as well. This would also focus on eliminating many of today’s added artificial colors, additives and preservatives that are often found in today’s processed foods. Literally thousands of chemical additives are allowed to be added to our processed foods, and these could easily add to the distortions of children’s behavior we often encounter in our society. In another study researcher from Columbia Un and NY State Psychiatric Institute analyzed 15 double-blind, placebo-controlled trials that involved 219 children who were fed a diet containing artificial food colors and then given a diet free of dyes. They found that the children’s behavior on the dye-free diet was significantly better than when they ate foods loaded with artificial colors. Other additives such as preservatives such as BHA , BHT, TBHQ, sodium benzoate, benzoic acid, aspartame, saccharin, sucralose, etc, certainly do not enhance overall health or mental performance, but when combined together, create a synergistic effect on brain dysfunction – the current state so many of our children are now experiencing.
Want to see better performing and better behaving young children? Then control the Franken foods they currently receive, and go with Real foods, some supplements and a loving environment. Thank you for your attention, Nick Tompanis
Nick,
Thanks so much for your thoughtful and comprehensive reply…. love the Franken food concept! We have been writing about almost everything you have mentioned here over the last 2.5 years, so you are right on with our readers. Much appreciate your pulling it all together!
cp
I was a Vyvanse patient for about a year and a half (was my neurologist’s first patient to try it once it came out). At first it seemed like a miracle stimulant compared to the others I tried but my opinion changed over time. After doing way too much research to find some answers about this drug I discovered a few things. Looking at all the reports, charts and graphs from the original NDA filing with the FDA several years ago (google “nrp104”) shows that Vyvanse actually has the same pharmacokinetic profile that Adderall XR does as well as the old dexedrine spansule formulation.
Another thing is the actual amphetamine content contained within each dose of Vyvanse is only 30%. A 70mg dose of Vyvanse only contains 21mg of amphetamine.
So what does it all mean? Well, Vyvanse really is not an extended release medication for the most part. It does have the unique ability to have a slightly slower ramp-up period but once it starts absorbing in the GI tract it follows that same profile as Dexedrine and Adderall XR.
Is Vyvanse a bad drug? No, not by any means. If anything it has been the most consistent over over choices such as Adderall XR. Vyvanse works each and every time and is very predictable. Adderall XR is not as consistent depending on meal/dosing but is still my #1 choice. Vyvanse is so consistent that my 70mg dose worked great each and every day for about 5-6 hours tops then it dropped off. For me, once a med peaks and drops I really don’t get any additional benefits of the medication despite the fact it is still in the body (but falling)….tolerance maybe?
Dr. Parker
I also wanted to know if coffee should be avoiding during this time of trying Daytrana.
Thanks
John
Dr. Parker
If one was to start Daytrana would they start by cutting the 10mg patch in half (to make 5mg) before moving up to cutting a 15mg (to make 7.5mg) and then moving up to the 10mg patch. How long (in days) should one stay at one level before moving up to the next level?
Thanks
John
John-
With all of the stimulants a steady state is often reached, depending of course on the biochemical individuality of the person, within about 4 days – but, cautious guy that i am, I usually wait about a week to save the patient much adjustment time and money because we pushed the process too much. When the therapeutic window narrows even more, with more precise dosing necessary – I wait for 2 weeks for the same reason.
Please also read on the PPT on the Daytrana post to help with specific titration [dosage adjustment] strategies.
I don’t think all coffee is a problem, simply using coffee in excess, and almost everyone intuitively knows about that issue [the med effect] once coffee is firmly on the table Biggest problem: they don’t tell me even if I ask – then we have a serious case of coffee denial and usually discover coffee OD after starting a stim med.
cp