Beyond Genetics in ADHD, Tourette’s, and Learning Disorders

Majid Ali, MD

An interview with the popular author Dr. Majid Ali. Select text was reprinted in Natural Treatments for Tics and Tourettes.

You know that in Latitudes we are looking at autism, Tourette syndrome, ADHD, and learning problems. Where would you like to start?

First, perhaps I can make a general statement. I think structural problems in the brain affect intellectual, sensory, and motor functioning. But there are also biochemical derangements that may not be demonstrable through a microscope, and these include neurotransmitter functioning, the action of endorphins, etc. Further, environmental triggers can aggravate or bring on these difficulties.

I believe that genes legislate life and our environment interprets it. Children with these problems you mention are genetically vulnerable. In fact TS and-ADHD often run in families.

Through Positron Emission Tomography (PET) scans, one can map out areas of the brain associated functionally or metabolically with certain phobias or obsessive-compulsive disorders (OCD). Though the technology is limited, progress is being made in this area. In one paper from Harvard, the two areas in which they demonstrated abnormal metabolic brain functioning when looking at these conditions were the prefrontal and temporal areas. If one were to treat phobias or OCD through Chinese acupressure, the two areas recommended for pressure, in a rolling motion, are the prefrontal area of the forehead and the temporal area. I find this an interesting correlation. What the Chinese had empirically determined many centuries ago is what we are now demonstrating with the PET scan.

As more and more people use PET technology, they are going to see a physiological overlap for autism, TS, CCD, and hyperactivity, just as we are seeing an overlap clinically.

The technology for determining the genetic makeup or vulnerability is there, but it is very expensive. Perhaps what we should focus on is another concept — that is, that 5 to 10% of the suffering may come from a structural, functional or metabolic derangement. But 90 to 95% of the suffering comes from factors that exaggerate the underlying problem.

By identifying and addressing the environmental triggers involved, we can address the problem itself. Let me give a specific example.

An ADHD Case

I had a young patient with severe ADHD and learning difficulties; he was in a special class at school. Many food sensitivities were determined. The boy’s mother was very committed to helping her child, and she carefully followed our plan for reducing food reactions. This is difficult, and not all families are well versed in it or willing to undertake the challenge. After six to nine months the condition was well under control, and the child had been able to reenter regular classes. Then one day I received a call from the mother, telling me that there had been a total breakdown and the youngster was back to where he had been when she first came to me. I asked all the usual questions regarding sugars in the diet, foods, changes in the home, and other environmental issues, but there were no clues as to what could have triggered this.

I suggested we use nystatin for two weeks. I knew this made sense because of his particular case history, but also because nystatin is generally wonderful for managing these types of crises. The reason for this is that any extra burden we can take off the child will help the child recover from this type of episode. Yeast overgrowth in the intestine is a common problem for hyperactivity. So, rather than give drugs, we decided to try that.

The mother called two days later and said he was 90% better. I asked our nurse to talk more to the family and see if they could find out what triggered the episode, but they drew a blank.

The next week the mother called, very excited, and said, “I know the answer! It was paint in the house.” I said, “I thought I asked you about paint.” But she explained that it had been in the grandparents’ home. Just prior to the initial relapse he had spent the weekend there, and the home had been painted the day before. Since it was wintertime, all the windows had been closed, keeping the fumes inside. I asked, “How did you learn that’s what it was?” She explained that her son had again gone to stay with the grandparents just this past weekend (at which time he had been doing very well). But within six hours, the grandparents called and said there was a relapse of symptoms and suggested they take him home. It was then that they started to think about what in the grandparents’ home, not just their own home, could have triggered the problem. Within a short time the boy’s activity level was stabilized.

This was a good clinical case in which we could identify a clear cause-and-effect relationship. But it also demonstrates that whatever genetic vulnerability he had, clearly the environmental triggers of paint fumes and yeast overgrowth (which goes hand in hand with food sensitivities) had been a major cause of the physiological stress.

How do you treat food sensitivity through diet?

The first four weeks we concentrate on an elimination diet-avoiding certain foods. After that, the family must stick to one principle: Don’t focus on what the person is sensitive to and can’t eat; focus on what you can and should eat. As long as mom is going to the regular supermarket and bringing all the typical stuff home, it’s going to be impossible to have good results.

This whole approach is a journey. No one becomes enlightened in matters of nutrition in a few weeks. We prepare patients that this is going to be a slow process. They will have to learn to use unusual grains or flours— amaranth, quinoa, spelt, artichoke. They have to learn to bring in buckwheat and items that don’t cross-react with common foods. Millet is excellent.

Of course, this has to be a whole-family project. When you do it for the child, you need to do it for the family, from a practical standpoint. Once a youngster’s condition has stabilized, he can probably take a break, within moderation, and eat something he is sensitive to, perhaps once a week or so.

What is the usual treatment if a child has experienced a chemical exposure?

I will speak in general terms from my own practice. I find supplements of taurine [an amino acid] very useful. Pantothenic acid (vitamin 135) is also a major element in detoxification. One thing that can be very useful is a combination of calcium, magnesium, and B12, as an injection. This can have remarkable results, because in one way or another, calcium is involved in almost all aspects of neuromuscular conduction, and magnesium is a key player in the process. This is where I would start.

If parents brought their child to you for treatment, what could they expect your initial approach to be?

The diagnosis is primarily clinical, and for the conditions your readers are exploring, symptoms and underlying factors often overlap. I would generally do a complete blood count (CBC) so we don’t miss simple things, like iron deficiency anemia, that might be compounding the problem. I typically run basic liver and kidney tests, and a simple calcium, magnesium, and glucose test. These won’t often be useful, but they are important so as not to miss an obvious problem. We often do a urinalysis, because many children have a subclinical urinary infection that can be linked to anemia.

Let’s look, say, at Tourette syndrome. If it were a difficult case, I would want to rule out a toxic overload of lead, mercury or aluminum. If a 24-hour urinalysis indicated an overload, I would consider (if the child has good veins) a therapeutic trial of EDTA chelation to reduce the body burden of any of these metals.

Allergies, including food allergy, would also be an area to explore. There are four ways to determine food allergies. One is an elimination diet. The next is skin testing, and another is an IgE blood test. Some people use IgG, but while I find it an excellent test for monitoring, I don’t like to use it for diagnostic purposes. In my own practice, I do electrodermal conductive testing to screen for allergies.

How does electrodermal testing work?

If you connect two points on the skin with electrodes, the skin energy and the tissue energy creates a current. It’s not a current from outside, it’s a current the patient’s own energy creates, called electrodermal conductance.

When you run an electrocardiogram, for example, you do the same thing. You put two electrodes in different parts of the body and you create an electrodermal conductance current that passes through the heart. You do an EEG brain graph in the same way. In food testing we use the Chinese acupuncture point for allergies, on the inner side of the middle finger, at about the second joint. We test one food at a time. The presence of the food creates the reaction.

Isn’t this considered a little far out by some people?

No — not a little far out, it’s too far out for some! But I get good results, particularly when facing a complex problem. Many people who have had other approaches for food allergy tell me the best correlation they have had is through this approach. The problem with this technique is that it can be subjective. It’s like a pathologist reading a breast cancer report. The accuracy depends on the pathologist.

Electrodermal testing aside, I think skin testing for food sensitivities can be very good. The reason I would prefer a blood test is simply that it’s easier for the child to handle. But I think allergists who are very skillful in skin testing should do it. If they are skilled with blood testing or an electrodermal approach, they should do that.

It seems environmental physicians differ significantly in the techniques or approaches they use. Should families be looking for doctors who use a particular technique in this field?

I don’t think so. My philosophy is this: if an environmental physician is conscientious, ethical, diligent, and knowledgeable, then he or she will be guided by the outcome of the tests he or she is using. By this I mean, if one is not getting a good outcome, a doctor with these qualities should be willing to adjust his or her approach.

In addition to food sensitivities, metal overload, and yeast overgrowth, do you see any common denominators with the conditions we look at?

Molds can be a very significant factor for autism, ADHD, and TS. After you diagnose a mold allergy, you have to desensitize the child. Mold desensitization is one of the most critical aspects of long-term management. Molds are in the body, in the air, in the water, in the refrigerator — and they are present all year round, while pollens are not. I would consider desensitization from molds on a long-term basis. On a short-term basis you may not see good results, but in the long run, you will.

We have been doing immunotherapy for molds for many years and we have extensive experience with it. I believe a neutralization approach with very small doses is good for short-term benefits, but a desensitization approach is better for long-term. Lab results support this.
Successful mold immunotherapy results in fewer infections and less need for antibiotics. Further, it often has a positive effect on. mental functioning.

Anything else?

Sugar is also a primary villain. People don’t recognize the physiological reactions that sugar can trigger. For example, we have established that people who are prone to panic attacks, have memory and concentration difficulties, or experience mood swings are often riding what we call a metabolic roller coaster. The primary causes are sugar and stress.

What we recommend is a breakfast of partially digested protein-protein powder with 90% protein, not those with 60% carbohydrates and fats. During the process of isolating protein from natural foods, there’s a partial digestive process, which allows the protein to be better assimilated. Even people who are allergic to milk can sometimes tolerate a milk-based protein mixture once a week, if they use other mixtures in between.

Ideally, the powder should be mixed with organic vegetable juice — fresh, if possible — or bottled juice. Soy milk, rice milk, and other liquids can also be rotated; occasionally, you can use organic apple or cranberry juice. Orange juice is an absolute no-no. No matter how you test for food allergies, orange juice is almost always shown to be a problem! Those with orange allergy can often tolerate lime or grapefruit juice.

It’s a process of retraining the child’s palate. We have three different types of protein formulas. One is based on rice — nutritionally the least desirable, but from an allergy point of view, most desirable. The second is based on milk protein — nutritionally most desirable, and from an allergy standpoint, least desirable. The other is soy-based. The person rotates these three mixtures. This is how I start the day.

What this protein breakfast does is eliminate the roller coaster insulin effect. If you compared the insulin curve after a child’s typical breakfast with the high-protein breakfast we advocate, you would be astounded by the result. After the protein breakfast, the insulin level might start at 5, go up to 15, then gradually climb down to 5; over the four hours you would see a gentle rise and fall. With the typical high-carbohydrate breakfast, it may climb from 5 to 150 or 175 — even 200 to 240, then it drops suddenly. The child gets hit as it goes up and as it goes down!

Insulin is a powerful trigger that affects adrenalin, a primary stress hormone. So what we are doing is setting these children up, before they go off to school, for a major metabolic change. When the insulin shoots up, it drives the sugar down, and that’s the beginning of the problems. Actually, we shouldn’t focus on the numbers so much, as on the rate at which they change.

Now, do we have to put a child through testing to determine this? Usually not. What we learn from adults we can empirically apply to children. We should have no difficulty recognizing the same type of glucose dysfunction in a six-year-old child as in a thirty-six-year-old man. If parents need objective proof-and sometimes this is helpful to win their cooperation-then we may run a test. There are times when talking in the abstract doesn’t work.

What about tests for various vitamin or mineral deficiencies in children?

I don’t like running unnecessary tests. For example, I generally don’t test children for mineral deficiencies — though a variety of tests can be done-because they are expensive. A complete profile for essential fatty acids, amino acids, and minerals can cost several hundred dollars.

Further, I would be most interested in changes in lab results, not just the numbers themselves. So, were I to rely on testing, I would want to first test the levels, then after several weeks of therapy retest, and again test after several months. This would be very costly to the patient, and insurance often does not cover it, particularly for the retests. I would instead initiate therapy based on my clinical evaluation and monitor the symptoms. Of course, there are times when I will determine these tests to be necessary.

We’ve received many letters from parents reporting that controlling Candida albicans has made a difference for their child. What should parents be aware of, particularly related to the use of antibiotics?

Antibiotics are sometimes necessary, but they are frequently given to children who have a common cold. It’s a virus, and obviously the antibiotic won’t help that. Sometimes after two or three days, a bacterial overgrowth can develop with the cold which may respond to the antibiotics. However, I rarely prescribe them — partly because those mothers seeking antibiotics go to their family physician rather than me, but also because I use herbal therapy first, such as echinacea, goldenseal, and astragulus.

Rather than use antibiotics for recurrent urinary tract and upper respiratory infections, I might use a combination of calcium, magnesium and B12. When you minimize the need for antibiotics, you have helped preserve the bowel ecosystem. This is one of the most important things you can do for youngsters on the autism-Tourette syndrome-ADHD spectrum. There is an ancient saying, “Death begins in the colon.” This is absolutely true.

Whenever there is a brain dysfunction, doctors in olden times would focus on the bowel — because, toxins not eliminated properly or produced in excess find their way into the liver. Then, of course, the liver does its job of detoxifying-but only up to a point. When the liver’s capacity is surpassed, these microbial toxins find their way into the brain.

You previously mentioned stress as being an important factor.

Yes, definitely. To address this, every Wednesday we have a meditation class. We teach mothers about meditation and ask them to teach their children. We try to make a game out of it; they can use a game of silence, a game of breathing. Now, in acute stages this technique might seem like a bad joke! But once the child is stabilized, it can be very helpful.

The breathing techniques are most valuable. It’s a simple mechanical process. Breathe in 1-2-3 and hold; breathe out 1-2-3-4-5-6-7.

It’s crucial to understand what most stresses a child. I’ve worked with many youngsters with panic problems and obsessive compulsive disorders. I’m thinking of an eleven-yearold boy who had arthritis to the extent that he had a limp. When he came to me, I asked, “If I could help you with one thing, what would it be?” I fully expected him to refer to his limp. But he asked, “Could you help me with my sensitivities?” He referred to his obsessive compulsive tendencies and concentration difficulties as sensitivities. It shows you how much they suffer inside and how little we understand their problems.

Do you use psychotherapy in your office?

I tend to exclude psychotherapy. I think compassion should come first. Further, physical approaches of changing your breathing patterns and adjusting your energy patterns can be very beneficial. I have seen damage done by some types of psychotherapy and mind-over-body techniques. I know many people would disagree with me on this. But I believe we should say what we think and be willing to accept the criticism. I am most willing to accept criticism on this point! I put spiritual work, meditation, breathing techniques, and energy work before psychoanalysis and psychotherapy. These techniques are ancient methods. There’s nothing magical about them. There’s nothing new about them. But they work. They may work slowly, but they do work.

Majid Ali, MD, is the author of seven books, including The Canary and Chronic Fatigue. He serves as president of the American Academy of Preventive Medicine and the Capital University of Integrated Medicine in Washington, D.C. Dr. Ali is a fellow in the American College of Pathologists and the American Academy of Environmental Medicine, and a diplomat in the American Board of Clinical Pathology, the American Board of Chelation Therapy, the American Board of Surgical Pathology, and the American Board of Environmental Medicine. He is also on the board of directors of the American College of Advancement in Medicine. www.majidali.com