The topic of the connection between diet and various brain disorders keeps hitting the headlines. Several years ago a study that literally shook the medical world was published in The Lancet, one of our major medical journals. This remarkable study was led by Dr. Lidy Pelsser of the ADHD Research Centre in the Netherlands. They found that a highly restrictive diet helps more than 50% of children with ADHD and in some cases the condition virtually disappeared. These findings set off a firestorm of controversy because they suggested that certain dietary changes appear to be more effective than medications for ADHD, a rather startling discovery. The children that did improve were on some type of restrictive diet. A working theory at the time was that ADHD was due to some type of food allergy. They assumed that certain markers of an allergic reaction including IgE and IgG could ferret out the kids with food allergies. These antibodies are often elevated in allergic reactions of any kind.
Back to the Future
Dr. Ben Feingold first promoted a similar approach in the 1970s. He proposed that certain food additives and dyes were responsible for ADHD and he developed a very restricted diet that was nearly impossible to follow for any length of time, yet in its day it was quite popular. Subsequence studies did not support this approach so it has largely fallen out of favor. The diet utilized by Dr. Pelsser although moderately restrictive did not focus on food additives or dyes but rather on the concept that certain children might be allergic to certain foods. In this study they used the “few-foods diet”, which includes rice, meat, vegetables, pears, and water, and can be complemented with specific foods such as potatoes, fruits, and wheat. In essence this was a simple whole foods diet that eliminated all highly processed food.
The Diet Brain Connection
The idea that diet might play a role in common brain disorders is not new. A healthy diet has been shown to reduce the incidence of depression. Other studies have shown that a healthy diet is associated with a lower risk of most common psychiatric disorders. Does this necessarily mean that certain dietary elements are causing these conditions? Let’s back up for a minute and carefully think this through. Long before we had our modern diet of highly processed food we experienced a certain incidence of common psychiatric disorders. Depression, anxiety disorders, bipolar disorder, ADHD and other common disorders have been around since the dawn of mankind.
I think it’s also important to acknowledge that in recent years the incidence of most of these disorders has been increasing at an alarming rate. As scientists we must come up with a plausible explanation for this observation. Some would say that years ago we simply weren’t diagnosing many cases of these disorders and today we have much sharper clinical acumen when it comes to identifying people with these conditions. There is only one problem with this idea—because I am old I was actually present back then. I know for certain that the incidence of these conditions has been increasing at a dramatic rate.
When You Miss a Common Disease You End up with a Confusing Mess
I do have my own ideas about why these conditions are increasing so rapidly. I believe that in the past these disorders were largely driven by genetic factors. The incidence of these conditions remained stable until the past 50 years or so. Let’s look at depression as an example. Up until recently major depression has always been associated with a loss of appetite and weight loss, which were defining characteristics of depression. Over the past 50 years we started seeing a lot of depressed people with an increased appetite and weight gain so the experts decided to include these parameters in the definition of depression. As a scientist I find this to be insulting—if a parameter qualifies you for a diagnosis throughout its spectrum, then you should throw it out because it cannot help you diagnose the condition!
We Need New Disease Models
There is another possible explanation for this phenomenon. As Dr. Pelsser points out ADHD is merely a collection of symptoms. Once you find someone with these symptoms then you need to look for a cause of these symptoms. If diet is a cause then that gives you a new therapeutic tool. I see things a bit differently than Dr. Pelserr. She found that around 60% of ADHD cases were influenced by diet. That means that a third of cases are not influenced by diet. In my opinion this group of people have the traditional ADHD that has been around for thousands of years. The diet sensitive group really doesn’t have ADHD at all. They have a form of food-induced brain dysfunction that I call Carbohydrate Associated Reversible Brain syndrome or CARB syndrome. This is a modern disease triggered by the consumption of highly processed food over a period of time. People with CARB syndrome can develop up to 22 distinct symptoms and many of these symptoms overlap with traditional disorders like ADHD or depression. How do you tell the difference between traditional ADHD and CARB syndrome that looks like ADHD? Those with traditional ADHD will have typical ADHD symptoms but won’t have any of the other symptoms of CARB syndrome. Thus the group of ADHD patients who seemed to respond to dietary changes in this study likely had CARB syndrome, not true ADHD.
It’s All About the Results
Why is it so important to differentiate these two groups? If you treat both groups the same way then in my experience therapeutic outcomes will not be equal. Those with traditional ADHD will tend to do very well when treated with stimulant medications like Adderall or Ritalin. Those with CARB syndrome will initially improve with these medications but over time they won’t do so well because these medications don’t address all the diverse symptoms of CARB syndrome. Although low dose medications can be helpful for controlling symptoms and improving compliance in CARB syndrome, you need to use a combination of a low dose dopamine/norepinephrine enhancing drug like Ritalin with drugs like Lexapro or Celexa that enhance serotonin. People with CARB syndrome have many symptoms that reflect dysfunction in the serotonin system and these symptoms are not present in people with true ADHD. Patients with both conditions can benefit with a precursor supplement like CARB-22. Low dose drugs and precursor supplements help to suppress the cardinal symptom of CARB syndrome—strong cravings for sweet or starchy food.
It’s All About the Diet
Once these cravings are suppressed it’s much easier for people to do what it really takes to overcome CARB syndrome—follow a healthy whole foods diet. I am partial to a Paleo style diet as outlined by Loren Cordain in his book The Paleo Answer or Robb Wolf in his book The Paleo Solution. A ketogenic diet as outlined in Jimmy Moore’s book Keto Clarity can be a lifesaver for those who are already metabolically damaged. When it comes to the anti-inflammatory effects of high dose omega 3 fatty acids, Barry Sear is in the expert and I highly recommend his book Omega Rx Zone.
One of the basic premises of this study was that certain foods cause an allergic like reaction somehow triggering ADHD. The mechanism of how this might happen has yet to be described. As it turns out, those children who had elevated immunoglobulioins IgE and IgG were no more likely to respond to dietary changes than those without these markers. Thus this study provided no support to the notion that food allergies play a role in ADHD. If isn’t about allergies, then what is it about food that seems to promote ADHD is some children? Unfortunately we don’t have controlled studies in humans indicating why a diet of highly processed food might adversely affect the brain. That’s why we tend to resort to developing disease models that support our underlying theories. Whether these competing models will live or die is based on a combination of controlled studies and empiric observations.
Until the studies are in I will go with the model that is supported by what I am observing in my patients. Theoretical models do matter. You would hopefully sail your ship differently in a flat world than you would in a round world. To date the CARB syndrome model seems to do the trick. When I stick to the model my patients seem to do better. Not just ADHD but a whole bevy of brain disorders seem to improve. Show me a model that gives me better results and I will start using it.
Is ADHD a Myth?
There is one more important issue to consider. Throughout this article I have assumed that non-CARB syndrome ADHD is a real disorder. I believe that after a careful review of the scientific literature this so-called scientific truth can be called into question. My friend Larry Hobbs recently sent me a copy of Peter Gotzsche’s summary of ADHD in chapter 5 of his excellent book “Deadly Psychiatry and Organized Denial”. He makes a strong case that ADHD is really a variation of normal rather than a true disease and he is strongly apposed to using medications to treat this condition. I highly recommend that you read his book before taking any medication to treat ADHD. As I mentioned earlier, low dose medications can sometimes be useful for treating CARB syndrome but they must be used very conservatively for only a limited period of time because dietary changes and targeted supplement form the core treatment of CARB syndrome.
I know, all of this seems a bit confusing. I am presenting information that is likely 180 degrees from what your own physician believes to be true. In my experience most physicians do care about the welfare of their patients but they are at the mercy of the propaganda spewed forth by special interests and drug companies. Insurance companies pay so little to primary care physicians that a “hi, goodbye” appointment is about the best you can expect. I give this knowledge and advice to you for free. I make my living at my day job as a Hospitalist and I give away valuable advice that I think will improve your health and well-being. My advice to you is to use you own cognitive skills and common sense to determine the best path for you to follow. I wish you luck and well-being on your journey.