ADHD, Sugar, and Thiamine

Attention-deficit hyperactivity disorder (ADHD) is a prevalent and debilitating disorder diagnosed on the basis of persistent and developmentally-inappropriate levels of overactivity, inattention and impulsivity. In this post we describe our use of Orthomolecular Medicine in the treatment of this condition, a term derived from a paper written in 1949 by Linus Pauling describing the discovery that sickle cell anemia was the first molecular disease to be discovered.

The word Orthomolecular is probably not well understood by most people and the phrase Orthomolecular Medicine would be meaningless to them. The prefix ortho means “the same as” and the prefix hetero means “different from”.  This means that Orthomolecular Medicine is the sole administration of substances that are recognized by the body as compatible with its normal function.  There is only one way of doing this and it is by the use of nutrients. Obviously, that means that prevention is obtained by the use of a diet that contains a complete list of the ingredients required by each cell for maintenance of its normal function. Mother Nature knows the precise number of the necessary substances: we do not. We have discovered many of them and called them vitamins. However, many of us strongly suspect that there are still nutrients to be discovered, thus demanding that naturally occurring food is the only food that we should be using to preserve a complete state of health.

Metabolic Disease and Disturbances

In the seventies, I was working in a multidisciplinary clinic as a consultant pediatrician. Pediatricians in private practice would refer patients where they considered that they needed some help. A common referral was a child with emotional problems and I was frequently confronted with the problem of ADHD and children with similar problems. At that time, emotional problems were considered to be caused by bad parenting and I would sit down with the parents, only to find that most of them had a completely healthy approach to this important discipline. However, when I asked about “diet”, I found that in nearly every case, this was appalling. These children were showered with “goodies” that gave them an enormous increase in empty calories, most of which were sugar containing.

My special professional interest was in a group of rare disorders known as “inborn errors of metabolism”. Each one of these diseases was inherited by a gene from both parents, resulting in biochemical changes in the child’s physiology. Most of them caused mental retardation if not recognized at birth and in some of them, mental retardation could be prevented by giving a highly specialized diet. That is why a biochemical “screening program” has been set up in a state-controlled laboratory in each of the states in the United States. The infant is subjected to a pin prick and a drop of blood is absorbed on a little piece of filter paper and mailed to the laboratory.

The missing genes in these diseases code for a specific metabolic reaction essential to normal function of the whole person and I began to think about why the brain was inevitably affected, no matter where the metabolic breakdown occurred. Although the cause of mental retardation is unknown, I began to think that the sole responsibility of food to generate cellular energy was the core issue of disease. I began to assume that energy deficiency may be the underlying cause of the mental retardation, although the mechanism was unknown. Could energy deficiency be the cause of some, If not all, disease?

The Importance of Brain Energy in ADHD

This kind of disease is extremely common, is not an “inborn error of metabolism” and since my clinical experience suggested diet as the underlying cause, it seemed to be necessary to study the details of how food generates energy. I wondered if dietary sugar had anything to do with the behavioral changes in the brains of these children. It seemed highly unlikely to be genetically determined because of its common appearance. Well, I found that glucose sugar was the primary fuel of the brain, so this seemed to deny that sugar could possibly be blamed. I began to study the details and found an enormously complex chemistry. I had learned some of this in medical school but had been told that I did not need to remember the details. All I needed for practice was to understand the general physiology of the body and which of the many medicines I would to apply when something went wrong. The emphasis was on making a diagnosis: with which of the many diseases was each patient confronting me? Then I could look up the disease in a medical textbook to see what was known about it. In each disease, the symptoms and signs were described in detail and ended with what was known about treatment. I can still remember how horrified I was to see in nearly every described disease that there was no treatment known. Of course, many changes have occurred since I graduated, but the success rate, particularly for chronic disease, is appallingly low.

It occurred to me that the complexity of how food is turned into energy presented the key to understanding why taking sugar caused brain dysfunction, in spite of the fact that a form of sugar called glucose is the prime fuel. The analogy of a car engine enabled me to see the answer. Some people will remember that cars had a gadget called a choke. It introduced a surge of gasoline to the engine, a so-called “rich mixture”. It was used to start a cold engine and had to be turned off when the engine warmed. Sometimes the choke stuck, thus permitting a “rich mixture” to the engine which promptly began to cough and splutter. The car slowed down and thick black smoke issued from the exhaust pipe. It is an example of fuel combustion efficiency. The rich mixture is too concentrated and overwhelms the ability to mix with oxygen and allow the spark plug to ignite the gasoline.

In the human body, glucose has to be ignited, but although the principles are identical to the car engine, the details are much more sophisticated. Thiamine and magnesium act as “spark plugs” by uniting the glucose with oxygen. If the food consists of too many calories, the mix with oxygen is overwhelmed: thiamine and magnesium are then insufficient to “ignite” the glucose. The brain is the most oxygen consuming tissue and it becomes compromised, resulting in changes in function that are expressed as symptoms such as ADHD. It would be fair to say that the engines of the brain cells, known as mitochondria, have been choked. Often times, in these and other cases, the measure of thiamine and magnesium are be found to be in the normal range, giving a false message that the ADHD is not due to thiamine/magnesium deficiency. The reality is calorie excess, relative to thiamine and magnesium, but the symptoms would be the same as true thiamine/magnesium deficiency in a person taking a healthy concentration of calories. It is the balance between essential vitamins and minerals and caloric intake, particularly of sugary foods, that is at the root of many diseases, including those ascribed to the category of ADHD. Perhaps before progressing down the medication rabbit hole with these children, a closer look at dietary contributors is warranted.

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