Ginkgo biloba for ADHD: A natural herbal treatment alternative?

A few weeks ago, I discussed the merits of ginseng for treating ADHD. What I did not mention is the fact that this special herb often works even better in tandem with another important "brain herb", Ginkgo biloba. It's benefits also extend beyond the nervous system, and the Ginkgo has been used to treat everything from increasing blood flow to Alzheimer's to glaucoma to hormone replacement to protection against neuronal degradation. While somewhat wary (personally) of using generalized "brain booster" nutrients for ADHD (it is a highly variable disorder of complex etiology and treatment methods), I am interested whenever new research publications arise on the topic. Just this week, a new paper came out on the merits of Ginkgo biloba as an ADHD treatment option.

Here are some of the major points of the publication:

• Irritability is an often overlooked side effect of ADHD. Medications, especially over-prescription with stimulants such as methylphenidate and amphetamines can increase this unwanted side effect. However, Ginkgo exhibited a positive mollifying effect on irritability for the individuals in the study.
  
  
• While one of the knocks against Ginkgo biloba is that it can sometimes result in sedative effects, the study found these to be extremely mild. However, to go along with the irritability-reducing benefits above, Ginkgo was able to improve the individuals' tolerance for frustration (to the degree that this behavior could be measured).
  
  
• We have seen previously that oppositional defiant behaviors are often comorbid to ADHD (which can often manifest themselves alongside seemingly unrelated disorders such as auditory processing disorders or even bedwetting). One of the strongest suits of Ginkgo biloba may actually be in curbing these oppositional behaviors. This suggests that Ginkgo may be effective for the more Hyperactive/Impulsive or Combined Subtypes of ADHD, where comorbid oppositional behaviors are more often seen (as opposed to the predominantly inattentive subtype of the Disorder).
  
  
• Nevertheless, Ginkgo biloba appeared to boost symptoms of attention and working memory as well. This may suggest Ginkgo's versatility, and that it could be used universally across the ADHD "spectrum", including for the 3 classic or traditional subtypes of the disorder.
  
  
• The study highlights the relative success for co-treatment with methylphenidate and clonidine for individuals with ADHD and comorbid anxiety disorders. The authors suggest a functional comparison between Ginkgo and clonidine, and hint at its use as an alternative to clonidine/methylphenidate treatment (of course, it is also possible that Ginkgo may be used alongside lower doses of stimulant medications, which could be very useful in reducing unwanted side effects, which are often mild for low doses of stimulants, but typically begin to appear with greater frequency when stimulant dosing is increased). Thus, Ginkgo could possibly act as a side-effect-saving alternative to higher doses of medication.
  
  
• As a precautionary measure, due, in part to some of its anti-clotting properties, there is some concern about Ginkgo triggering internal cerebral bleeding. Indeed, other studies have also addressed this possible concern, highlighting issues such as haemmorrhage risks, as well as herb-drug interactions with Ginkgo and anti-coagulant medications.
  
  
• Keep in mind the extremely small nature of the study (only 6 individuals) should be met with healthy skepticism. However, the results were still notable. Statistically significant reductions in some of the trademark ADHD symptoms (fidgeting, restlessness, inattention, etc.) upon Ginkgo biloba treatment definitely highlight its potential as a more "natural" alternative treatment method for ADHD.
  

Can ADHD be Treated with Ginseng?

The Theory Behind Ginseng as an ADHD Treatment Option:

Ginseng is well-regarded for its memory boosting, sleep improving, and brain-saving longevity benefits. In a general sense, it appears that it would be a good potential treatment method for ADHD and related disorders. Although successful clinical study publications on the specific use of ginseng for ADHD are relatively scarce, it appears that on at least a theoretical basis, this popular herb could work for treating ADHD and related disorders. I would like to highlight some of the biochemical and physiological reasons supporting its use as an alternative treatment for ADHD:

1. Compound diversity in ginseng: Ginseng is not simply one isolated compound, such as an individual drug, but rather a mixture of substances of potential pharmaceutical benefit. Among these are a family of compounds called ginsenosides. One of the underlying benefits this (and herbal treatments in general), is that many of these related compounds can work together in a synergistic fashion, nature's own alternative to drug cocktails. Given the fact that absorption, metabolism and utilization of biochemical agents for the treatment of disorders is rarely due to one isolated substance of pharmaceutical value, this multi-compound treatment method certainly has potential advantages over a single-drug treatment method for ADHD or related disorders.
   
   
2. Ginseng, dopaminergic activity, and ADHD: It has been demonstrated that herbal extracts of ginseng can exhibit activities that target the dopaminergic (dopamine-related) pathway and can exhibit neuro-protective benefits for these pathways. This is important, because ADHD is often chemically characterized by deficits in this pathway, which typically include reduced dopamine levels in the regions between neuronal cells throughout various key regions of the brain (ones that, among other things, are responsible for attention span, screening out irrelevant stimuli, and impulse control). There are even implications that ginseng compounds can accelerate the neurodevelopment process from stem cells.
   
   
3. Boosting of "synaptic plasticity": During the learning process, a certain amount of "agility" is necessary in the regions in between the cells as the brain begins to rewire itself to conform to the newly learned material. The ability of neurons to form new connections is referred to as synaptic plasticity. It appears that ginseng contains several key elements which helps maintain this "pliable" learning-friendly state. Essentially, compounds isolated from ginseng can moderate long-term potentiation, (long term potentiation refers to a learning and memory process in which communication between two neuronal cells is improved or made more efficient by stimulating both cells at the same time. This plays an important role in the development and maintenance of long-term memories). Given the fact that learning disabilities are frequently seen in ADHD (often more on the inattentive side of the ADHD spectrum), it stands to reason that ginseng may be useful in some of these comorbid learning-related deficits as well.
   
   
4. Ginseng boosts aerobic glucose metabolism in the ADHD brain: The ADHD brain typically contains deficits of glucose and oxygen (as determined by multiple imaging and brain scanning studies) in many of the key brain regions which modulate attentional control, impulsivity, and concentration. It is even postulated that ADHD may be an "energy deficient syndrome". Brain metabolic studies indicate that aerobic glucose metabolism is typically improved in the presence of ginseng isolates. Not only does this reduce some of the potentially brain waste products associated with oxygen-deprived brain activity, but this enhanced aerobic form of glucose metabolism in the brain is a more efficient process.
   
   
5. Ginseng may boost dopamine and norepinephrine levels: As mentioned previously, individuals with ADHD are typically deficient of the important neuro-signaling agent dopamine in key regions of the brain. However, a deficiency in another important neuro-signaling agent called norepinephrine is also frequently seen in the ADHD brain. Imbalances of both dopamine and norepinephrine are seen in ADHD patients, and can lead to disruptions in physiological processes such as attention span, complex cognitive processes, auditory processing delays, and motor behavioral dysfunctions. It is believed that the ginsenoside compounds (see point #1) may help alleviate some of these ADHD-related symptoms by boosting levels of dopamine and norepinephrine in these key brain regions, several of which are affiliated with ADHD.
   
   Interestingly, many stimulant meds for ADHD work by boosting levels of these same two compounds, meaning the effects of ginseng may approximate those of a stimulant medication used to treat ADHD. We will see in the next post how another natural brain supplement, Ginkgo biloba, may better approximate the action of non-stimulant ADHD medications. It is also worth noting that isolates of ginseng and ginkgo may work in tandem to boost memory and other related functions.
   
   On a side note, fatty extracts of the ginseng plant have been used to alleviate the dopamine-dependent "high" of cocaine, which supports the use of ginseng as a potential treatment agent for cocaine addictions. Similar results support the use of ginseng for treating nicotine addiction as well. This further validates the dopamine-dependent regulatory benefits of ginseng and its ability to stabilize fluctuations in neuro-signaling agents of relevance to ADHD.
   
   
6. Ginseng may protect against brain damage from excess iron: I have personally advocated the use of iron for treating ADHD in several other posts. It can counteract toxic effects of lead and other metals, improve the synthesis of dopamine from the dietary amino acid tyrosine, and improve sleep quality in ADHD children. However, there are several dangers associated with excessive iron supplementation, one of which is neuronal death and neuro-degenerative diseases such as Parkinson's. However, there is some evidence that ginseng can counteract this iron-related neuronal damage by regulating specific iron-transporting proteins in the brain. If these findings hold true, then ginseng might be of use as some type of "insurance measure" against potential damage from excessive amounts of iron supplementation designed to treat ADHD.
   
   
7. Promote nerve growth in brain regions typically under-developed in ADHD: We have reported earlier on some of the delays in maturation and development of specific brain regions in ADHD. Some research suggests that ginseng compounds may promote neuronal growth and development in the early stages of life. While currently a bit of a stretch, findings such as this may lead to the use of ginseng compounds to offset ADHD-associated neurodevelopmental delays somewhere down the road.
   
   
8. Neuroprotective effects of ginseng for the aging ADHD brain: This may be especially relevant to adults with ADHD as they age. In addition to its ability to help with neuronal cell development in the early stages of life (mentioned in the previous point), evidence suggests that the active ginsenoside "Rd" compound in ginseng can alleviate inflammatory damage and death to neuronal cells. Given the fact that early neurodegenerative effects are often present in ADHD-like mammalian systems, these results at least suggest that ginseng may be a potential life-long treatment option for individuals diagnosed with ADHD.

Magnesium Deficiency and Childhood ADHD

Magnesium Levels and the Connection to ADHD
In the last blog post, we talked about how an iodine deficiency in pregnant women can lead to ADHD and other cognitive dysfunctions in children. Iodine is just one of the many key nutrients that have been correlated with a worsening of ADHD-like symptoms. The effects of deficiencies for more well-known minerals such as iron and zinc are widely published. Low levels of both of these minerals have been associated with the onset of ADHD, and will be discussed in later posts. However, a lesser-known but equally important mineral relevant to ADHD and overall brain function is magnesium. There have been multiple studies linking low levels this key nutrient to an increased onset of ADHD.

Signs and Symptoms of Inadequate Magnesium Intake
Magnesium actually shares a functional overlap with iodine as far as proper bodily function is concerned. It plays a crucial role in maintaining function in a number of enzymes and other essential proteins. Additionally, like iodine, magnesium is essential for adequate bone health as well as maintaining adequate body temperature and energy levels. There are a number of signs of magnesium deficiencies which actually mask symptoms of other diseases, but some of the most distinctive signs of low magnesium levels are unexplained ulcers in the mouth area. Additionally, while allergies and asthma occur at higher levels in individuals with ADHD as comorbid disorders, the presence of ADHD, allergies, asthma and fibromyalgia (high levels of constant pain and sensitivity to touch) can be due to inadequate magnesium levels in the body.

Frequency of Magnesium Deficiencies and Recommended Daily Amounts
Like iodine, magnesium deficiencies are relatively common in industrialized countries. In children, these trends are even more ominous, with some estimates placing up to 90% of children in the magnesium deficient category. Recommended amounts typically fall within 280 to 400 mg per day, with men requiring slightly higher amounts than women. Seeds and nuts are among the best sources of this vital nutrient, with one of the best options being pumpkin and squash seeds (1 ounce provides about a third of the recommended daily amount).

**Please keep in mind that the recommended magnesium levels of 280 to 400 mg are for adults and older children. For newborns (around 30 mg/day) to children under 9 (130 mg/day), the requirements are lower. While there are no "food-based" upper limits for magnesium, there are for supplements. This is due to in part to different absorption patterns of the different magnesium forms in supplements as opposed to foods. Please click here to see some tables for recommended and upper limits of magnesium for children. Also, keep in mind that certain antacids and laxatives contain high levels of magnesium already, so please follow the upper limit max for supplements.

Treating ADHD with Magnesium Supplementation
Given the relatively low consumption of these foods by individuals in westernized countries, as well as the prevalence of nut allergies, supplementation with magnesium is another good option.
While both of the main components of ADHD (inattention and impulsivity/hyperactivity) are both associated with low levels of magesium, it appears that the hyperactivity factor is even more pronounced. The effectiveness of magnesium treatment is boosted by another key nutrient in the family of B vitamins, namely Vitamin B6. My next blog post will go into more detail about this treatment combination for ADHD.

Iodine deficiency or ADHD?

We have alluded to the fact in previous posts that ADHD symptoms can sometimes either be triggered or mimicked by nutrient deficiencies. If this is the case, then we can argue that by increasing the levels of these nutrients via food intake or supplements could ameliorate some of the negative features of the disorder.

While vitamin, mineral, protein and omega 3 fatty acid deficiencies often steal the spotlight for dietary intervention strategies for ADHD, there is another, less-heralded connection and treatment that deserves considerable attention. According to multiple journal articles, reviews and studies, there appears to be a correlation between an iodine deficiency and an increased likelihood of developing ADHD.

One such study on ADHD and iodine was published in the Journal of Endocrinology and Metabolism in 2004 by Vermiglio and coworkers. This study found that mothers who were iodine deficient were more likely to give birth to children with ADHD. While numerous nutritional deficiencies are often predominantly linked to Third World countries, Iodine deficiencies are surprisingly common in industrialized nations. Although little attention is often paid to this topic, the results of an iodine deficiency can be quite severe.

Since the thyroid gland and the hormones it secretes are heavily dependent on this key nutrient, low levels of iodine can lead to problems such as poor circulation and body temperature regulation, reduced energy levels, inhibited brain development and dysfunction, improper calcium levels in the blood and bones, and impaired immune function.

In a nutshell, the study examined the rates of ADHD in children who lived in 2 different regions, a relatively Iodine-rich region (where iodine deficiencies were more commonplace) and and Iodin-poor region. The 10-year study, which had a relatively small sample size, found that the rates of ADHD born to mothers at risk for facing an iodine deficiency was significantly higher than the rates of those born to mothers in a more iodine-sufficient environment. Furthermore, IQ scores were statistically lower in the low-iodine group.

We need to be careful not to lump ADHD into a general category of cognitive decline. After all, a very large percentage of individuals with the disorder are of average or above-average intelligence.

The overall mechanism of low iodine and the onset of ADHD is not completely clear, but there is a known correlation between low hormone levels (those secreted by the thyroid gland) and ADHD. Other studies, including one in the New England Journal of Medicine, have shown that individuals with a built-in resistance to thyroid hormones have higher incidences of ADHD. Individuals with a specific genetic mutation to the thyroid receptor-beta gene, are resistant to specific thyroid hormones and have roughly 3 times the risk of developing ADHD than the general population.

In the low iodine study, it appears that there was a bias towards hyperactive and impulsive behavior (as opposed to inattentive behavior), but with the small sample size used in the study, we should not put too much weight into this possible connection. Nevertheless, it is at least worth mentioning. Additionally, abnormal weight gain can also be a sign of an iodine deficiency, so an unexplained increase in weight accompanied by an increase in ADHD symptom severity may be due to an iodine deficiency and thyroid dysfunction.

Simple clinical tests can be done to determine whether an individual is iodine deficient and/or has thyroid dysfunction. One of the most common measuring devices is testing for the levels of TSH or Thyroid Stimulating Hormone. If an individual has underactive thyroid function (such as that caused by insufficient iodine intake), then the body tries to compensate for this by boosting thyroid function through increasing levels of TSH. Therefore, high levels of TSH correlate with an abnormally low thyroid function. Not surprisingly, in the pregnancy study on ADHD and iodine deficiency, mothers of ADHD children typically had elevated levels of TSH.

So how do we boost dietary iodine levels quickly and efficiently (the recommended daily amount is 150 micrograms, if that number means anything to you!)? One of the easiest ways is to replace common refined table salt with either iodized salt, or iodine-rich sea salt. Ocean fish and seaweed are also good bets as iodine-rich food sources.

One particularly good piece of information is that the developing fetus is surprisingly resilient to early stages of iodine deficiency in the mother if the iodine deficiency is corrected before the third trimester of pregnancy. Since the effects of an iodine deficient diet can be severe to both mother and child, I highly recommend pregnant mothers to switch to iodized salts or sea salt during the pregnant and nursing stages. This simple practice can significantly reduce the risk of ADHD and cognitive dysfunction in their child's future.

Natural Treatments to Try Before ADHD Medication

We have been spending a lot of time recently on medications for ADHD. However, one question we should always be asking ourselves is: "Are medications always necessary?".

Believe it or not, there are a number of nutritional deficiencies that can trigger ADHD-like symptoms or worsen the disorder. There are definitely instances where merely fixing key nutritional imbalances over a period of a few weeks can lead to positive results.

Before we go any further, we need to examine how this all works out. It helps to think of ADHD as a puzzle, where one or more pieces are missing. If we can correctly fill in the missing puzzle piece(s), then we can treat the disorder. Of course this is oversimplifying it a bit, and no, nutritional and "natural" strategies do not always work. Nevertheless, I believe they are grossly under-utilized. After all, if a vitamin supplement gave the same results as an amphetamine-based drug, which one would you choose for you or your child? The answer is a no-brainer.

Based on a keynote article on Ritalin vs. supplement treatments for ADHD, which is frequently cited by the "natural cures for ADHD" crowd, we see compelling (albeit limited) evidence that natural supplementation can be as effective as Ritalin for treating ADHD. It sounds intriguing, but it is also important to note that too much weight is often placed on this study. Why? Because all of this information is based on the results of only 20 individuals (10 whom took the Ritalin and 10 who took the dietary supplements). Of course we should not discount the research because of a small sample size, but out of the millions who suffer from ADHD, do we really want to hinge a bunch of expectations on 20 individuals? Nevertheless, the results are worth reporting and are due much further investigation.

Here are 9 different possibilities cited by the article for nutritional deficiencies or environmental factors which could affect the onset of ADHD (I subdivided one of the categories, there are only 8 in the original article). I will list them here, and investigate each one in more detail in later posts:

1. Food allergies and food additives
2. Toxic effects of heavy metals or environmental contaminants
3. Protein-carbohydrate imbalances
4. Mineral deficiencies or imbalances
5. Fatty acid deficiencies or imbalances
6. Amino acid deficiencies or imbalances
7. Thyroid dysfunction and iodine deficiencies
8. B vitamin deficiencies
9. Antioxidant levels, including phytonutrients and polyphenols (found in fruits, vegetables, coffee, teas, wines, beer and a few other sources).

Using Zinc to Boost Ritalin's Effectiveness

We have seen that combining stimulant and non-stimulant medications for ADHD can be effective, as evidenced in a previous post on how Risperidone boosts ADHD stimulant medication effectiveness. We have also explored how supplementation with the amino acid tyrosine can boost the effectiveness of clozapine. Now we will be examining another non-medication compound, zinc sulfate and its effects on the popular ADHD drug methylphenidate (Ritalin, Concerta).

Most of the information in this post is gleaned from a 2004 article in the journal BMC Psychiatry on Zinc Sulfate and methylphenidate for children with ADHD. Some key points are listed below:

• The study compared children with ADHD of both genders, ages 5-11 who took either: methylphenidate with zinc sulfate (15 mg zinc) to those who took methylphenidate by itself (with a sugar placebo) for 6 weeks. Results on treatment effectiveness were determined based on both parent and teacher ratings for ADHD behaviors, as well as psychiatrist evaluations every 2 weeks.


• Zinc is required for the proper function of over 100 different enzymes in the body and previous research has shown that a deficiency in this important mineral can be associated with ADHD.


• Zinc also helps regulate levels of the important compound melatonin, which plays a significant role in regulating sleep patterns in individuals both with or without ADHD. Melatonin also plays an important role in regulating levels of the brain chemical dopamine, which is a key factor in ADHD.


• All children in the sample were of the combined subtype (one of the 3 major subtypes of ADHD, which includes hyperactivity, impulsive behavior and inattention), and had not received previous ADHD medications.

• The study found that ADHD symptoms decreased following the 6 week period for the methylphenidate group, but an even more pronounced decrease in negative symptoms when the methylphenidate was combined with zinc. These trends were statistically significant in both the parent and teacher rating studies.

• (Blogger's point, not from article): Based on previous studies and blog posts on the ADHD stimulant medication Adderall, we have seen that psychiatrists generally see even greater levels of improvements for ADHD treatments than do parents or teachers. If this trend holds true to this treatment, then it is possible that these positive effects may be under-representations of the real potential of zinc-methylphenidate combination treatment.

• (Blogger's remark, not from article): While this study showed promise, it did not compare zinc-methylphenidate treatment to zinc treatment by itself. In other words, we cannot tell if zinc treatment actually amplifies the effects of the medication or if it simply targets additional symptoms of the disorder. Given the fact that zinc deficiency is common in individuals with ADHD, it may be the case that zinc supplementation, not methylphenidate may be the main effective treatment factor. Look for future posts on zinc supplementation and ADHD.

ADHD Gene#4: Dopamine Beta Hydroxylase Gene (DBH)

ADHD Genes


ADHD Gene #4: Dopamine Beta Hydroxylase Gene (DBH), Location: Chromosome 9 (q34)

Dopamine Beta Hydroxylase (DBH) is the fourth gene on our list of ADHD Genes. For humans, it is listed on the 9th Chromosome ("q34" refers to a the specific location on the chromosome for the gene). For a list of the other ADHD genes that are being discussed, please click here.

What makes this DBH such an interesting gene associated with ADHD is the fact that several diseases or disorders that are often comorbid (existing alongside of or with) ADHD also have ties to this gene. Among them are smoking (both in tendency to smoke and the number of cigarettes smoked per day) and suceptibility to migraine headaches. Additionally, there is a suggested genetic linkage between a particular form (allele) of this DBH gene and a built-in resistance to Parkinson's disease. Of somewhat interest is the fact individuals with ADHD are statistically more susceptible to contracting Parkinson's later in life than the rest of the general population.

In studies with mice, an analogous DBH gene has shown to play a strong role in regulating body temperature as well as being a key component in response and sensitivity to common antidepressants including Prozac, Paxil and Zoloft.

A major function of the Dopamine Beta Hydroxylase (DBH) gene is to produce an enzyme of the same name, dopamine beta hydroxylase. This enzyme is responsible for converting the important nervous system chemical dopamine into another important chemical called norepinephrine. Individuals with ADHD often show abnormal levels of one or both of these chemicals (typically on the low side). For this enzyme to function properly, it requires adequate levels of the mineral copper as well as ascorbate (a form of Vitamin C). Deficiencies in either of these two dietary components inhibit this enzyme's effectiveness and produce similar symptoms to a DBH deficiency. It is therefore advisable that ADHD individuals take in adequate levels of both of these key nutrients (roughly 2 mg/day for copper for the average person and at least 60 mg/day for vitamin C).

However, even with adequate intake of these two nutrients, ADHD symptoms can definitely persist. One of many possible causes could be an inherited form of the DBH gene that is statistically linked to ADHD. This can be determined by a personal genetic screening. One allele (form) of this ADHD gene is called the DBH A1 allele. Several studies have shown that there is a significant association between this A1 form and ADHD.

In addition, there is some evidence that another allele (form) of this DBH gene on the 9th human chromosome may also play a role in developing ADHD. This form is called the DBH A2 allele. Although there is a somewhat weaker association between this form of the gene and ADHD than the A1 form, several family studies have shown a notable correlation between the presence this form of the gene and the development of ADHD. Additionally, some research has suggested that the presence of this A2 form of the gene is tied to a parental history of ADHD (often with a higher correlation to the father), and the subtype of ADHD. Some evidence (which has not been repicated extensively) points to a correlation between this A2 form of the gene and an ADHD subtype called the combined subtype.

The combined subtype refers to a subtype that encompasses both the inattentive component and the hyperactive/impulsive component. The inattentive component has been tied to two other "ADHD genes" previously discussed, the DRD4 gene, and the DRD5 gene, while the impulsive/hyperactive component of ADHD which has been associated with another previous post of a gene and its "ADHD form" called the DAT gene.

The next post will soon be up on another "ADHD gene" of topic, the Serotonin Transporter Gene (5-HTT).

For a list of other posts on ADHD Genes, please click here.

ADHD genes