|
Welcome back! I hope you enjoyed the last issue’s introduction to ADHD and root causes. If you haven’t read it yet, you can find it here. The ADHD brain is fascinating and full of unique strengths and advantages. However, its neurodivergent wiring can also make life feel overwhelming and frustrating at times, especially when it comes to managing distractions, calming feelings of overstimulation, and finding effective strategies for day-to-day life. This week we are exploring assessments to understand what is happening inside the body. Nutrient status, blood sugar balance, neurotransmitters, and even digestion and the microbiome - and more! - can trigger or worsen symptoms of ADHD. In Wellness, Mary Virginia Where to Begin On Your ADHD Journey First things first: Test and assess, don’t guess! Your first step will be to find a reliable psychologist, psychiatrist, or other appropriate ADHD-informed practitioner who is trained in ADHD diagnosis and other brain/psychological conditions. Remember to trust yourself and your experience during this process! Be open and clear about your symptoms. Seek a practitioner who listens actively during your work together. It's important to pursue a proper diagnosis to determine whether the symptoms you see are actually ADHD or some other issue, or perhaps even a complex presentation of several conditions. We can’t just assume it’s ADHD (or only ADHD) even if the symptoms seem to match up pretty closely. After this, we can explore the underlying factors so you and your care team can define what interventions will work best for you, from medication to food/nutrients to lifestyle patterns. Getting the Full Picture: Let’s Get Clinical One of the coolest things about the nutrition care process is that my clients discover how much their daily food and lifestyle choices affect how their bodies and brains function. It’s really empowering! As the expert of yourself, you have the privilege of using this information to experiment and find out what works best for you. The exploration we do in a nutrition clinic illuminates both how your unique body is natively designed to interact with the world around you (your genes) and how it is actually functioning right now. Our discoveries are made through a structured process of lab tests, taking a look at the signs from your body, and learning more details about your symptoms. These assessments altogether show us what’s working well and what parts of you need more support - everything from your genetic pathways to your digestion to your stress response. Out of this data blossom personalized options for rebuilding wellbeing. Most of all, realize that there is no one-size-fits-all approach to interventions. Each person comes with a unique biochemistry, environment, family life, co-existing conditions (I refer you to Volume 132 again), and more. Standard Blood Work These are blood tests that you (or I, with your permission) can request from your doctor. They give us information on your nutrient status for things like protein, electrolytes, vitamins, and minerals and on your metabolic health and energy production, e.g. blood glucose, cholesterol, and thyroid health. Every cell in our body requires nutrients to function. Our energy is produced because of a series of nutrients we get from our food + oxygen. Our body is built out of protein and minerals. Our brains and nervous systems must have amino acids, electrolytes, and B vitamins, but also iron, magnesium, vitamin C, and more. When I look at standard blood work, I see a whole world of your nutritional status. And just like it sounds, standard blood work gives the best information when we get it at least annually. We will determine which tests are most useful for you when we take your health history. Here’s a list: please know that I just touch on some of what we get from them. Complete Blood Panel with Differential (CBC with Immune Markers) A marker for iron, B vitamins, hydration, immune response, and more. Comprehensive Metabolic Panel (CMP) A marker for glucose (blood sugar), sodium, potassium, calcium, proteins, liver and kidney function, and the acidity of your blood. Lipid panel Cholesterol markers and triglycerides (blood glucose, thyroid, stress, and hormone related). Homocysteine A marker for B vitamin and choline status; influences the body’s master antioxidant/detoxification; affects the heart and blood clotting. Hemoglobin A1c, Glycomark Blood glucose measurements: amount over time and spikes/dips. Insulin, C-Peptide Insulin measurements; how the body addresses elevated blood glucose. Thyroid Panel TSH, Free T4, Free T3; energy production; metabolism of food; growth; physical and brain development. Iron Panel We can look first at hemoglobin, hematocrit, and RDW for iron status; iron is necessary to transport oxygen to make energy. Also used to fight infection. Magnesium Over 600 biological processes need magnesium! Folate Blood cell production; DNA repair; cell division; neurotransmitter synthesis (and more). Can assess somewhat from the CBC in MCV, MCH, MCHC, and RDW, too. Vitamin B12 DNA synthesis; blood cell production; nerve function; turning food to energy. Can assess somewhat from the CBC in MCV, MCH, MCHC, and RDW, too. Vitamin B6 Genes and genetic pathways related to mood, focus, melatonin synthesis, and brain development require B6. Celiac Disease Testing Celiac disease can interfere with the absorption of nutrients as gluten creates inflammation that damages the lining of the digestive tract. Additional Assessments Assessments can also include hormonal status, such as whether the client is in perimenopause or menopause or struggling with too much/little estrogen or testosterone. Separately, it’s typically very helpful to have environmental allergy testing and to do an assessment for food allergies. The histamine increase related to allergy, including food allergy and sensitivities, can make ADHD symptoms markedly worse. Let’s Get Functional, Functional! Functional testing literally means that we are assessing how your body is functioning! These are a series of specialized tests that give a more nuanced picture of what’s happening that may be disrupting the flow of your physiological and biological systems and contributing to your symptoms. For example, we can look at your gut microbiome in a stool panel, or determine how well you are making and metabolizing your mood and focus/attention neurotransmitters via an organic acids test. Stool Panel Assess digestive health and food metabolism (Tiny Health; GI MAP; GI360, others). A referral to a gastroenterologist might also be considered, depending on the GI symptoms. Organic Acids Test This in part assesses nutrient status, neurotransmitter metabolism, HPHPA (which can interfere with dopamine metabolism), and candida/yeast (Mosaic, Diagnostic Solutions, Genova, others). Mold Testing I’m most familiar with Mosaic. Hair Testing for Heavy Metals Heavy metals in the body can bind nutrients and bind to receptors on cells, wreaking havoc with health (High lead can lead to ADHD symptoms). Consider Genetic Testing Genetic testing provides information on your genetic blueprint and evaluates risk. Risk, however, is not the same as outcome! Epigenetics is the influence of the environment on gene expression, and this is why all genetic information must be evaluated along with lab tests and clinical assessments. Since ADHD is highly influenced by dopamine status, it’s interesting to see how the body is natively designed to synthesize and metabolize dopamine and dopamine receptors on neurons. This includes dopamine related genes, plus MTHFR, COMT, and others. 3X4 Genetics provides nutrigenetics/nutrigenomics testing to understand how your body interacts with nutrients and which biochemical pathways might benefit from additional nutritional and lifestyle practice support. I order the 3X4 Genetics test for my client. When the kit arrives, the client registers it and includes my practitioner code: MCOF001. That way I will receive the results and will be able to interpret them in the full context of my clients health status. Full Clinical Functional Evaluation And finally, there is what we learn from detailed clinical forms and our conversations with each other! My own forms gather a ton of information, and I have been told many times by clients that they had not considered their constellation of symptoms and timeline of health and life experiences so fully before this. We connect a lot of dots that let us get started in shaping our next steps. Comprehensive Medical and Social History This includes all medication, recent blood work or other testing, and diagnoses, and also your life experiences. Nutrition Focused Physical Exam It’s amazing what our bodies tell us about our health and nutrient status by what we see just looking at each part of them. Detailed Review of Food Choices and Current Supplements Not just what you eat, but also how you eat it, your food environment, likes/dislikes, cultural considerations, etc. Lifestyle Choices and Behaviors Sleep, movement, time in nature and sun, relationships, stress, hobbies/pleasures, mindfulness/faith practices, environmental components, etc. But Wait, There’s More! Delving into how to support those with ADHD to function with more joy and success in their worlds has been eye opening even for me. It’s a rich fabric of opportunities to understand and to support the ADHD brain and body.
So come back for the next issue! I’m going to detail evidence-based interventions that truly make a difference to make the daily life of someone with ADHD easier and more pleasant.
2 Comments
Welcome to 2025! I hope you had the most wonderful holidays, including some time to rest! We all need a minute to regroup after being completely out of routine for a couple of weeks. This special Inner Workings double issue is dedicated to ADHD, its symptoms, root causes, and nutritional and integrative interventions. We have something for everyone, whether you experience life through an ADHD lens or support others on their journey. It’s been fun to bring all of this info together in one place! Today’s first half discusses the definition and symptoms of ADHD, who is diagnosed with it (some surprises here!), common co-occurring diagnoses, and key underlying root contributors. Our next issue in two weeks will present nutritional and lifestyle interventions that really work to ameliorate the symptoms. This is a complex topic, and I hope that you will reach out to me with your questions or thoughts. In Wellness, Mary Virginia I’ve received a lot of education on supporting adults with ADHD. For these tandem articles on ADHD, I have drawn from research, my trainings with Dr. James Greenblatt and Camille Freeman DCN, MS, RH (AHG), LN and from the deep dive podcast ADHD and How to Improve Focus by Andrew Huberman (The Huberman Lab). What is ADHD? Attention Deficit/Hyperactivity Disorder is a type of neurodivergent (vs typical) brain wiring that results in challenges in activities of daily living. Importantly, the person with ADHD is not being willful: this is really how their brain works. Any combination of the following symptoms might show up in an individual with ADHD:
ADHD hits hard on executive function, the parts of the brain that provide organizational structure and time management along with task completion. Those with ADHD brains are often intuitive, creative, and quick, and they can have amazing native intelligence. Any given experience for those with ADHD is often wired to emotion. It barely touches or skips past the brain’s executive function areas and goes straight to the emotional/limbic part, which is very close to our primary site of memory storage. Seeing and processing the world through a unique lens inspires different connections than neurotypical folks. Many remarkable inventors, artists, comedians, and entrepreneurs have had ADHD, but also lawyers, doctors, and business people. That said, it can interfere enough that even the brightest people sometimes can’t get traction in work or relationships. They struggle to integrate diverse sources of information, and have difficulty imposing useful structures, boundaries, and patterns where needed. My own experience with ADHD is that there is a spectrum, from somewhat neurodivergent to highly impaired. Regardless, it’s not formally ADHD unless it is diagnosed. How is ADHD diagnosed? ADHD is diagnosed when a trained provider clinically confirms 6 or more symptoms in one or more of the domains below in a child <17 years old, or 5 or more in an adult >17 years old.
While most of us will experience some symptoms that are like those of ADHD, they may be the result of our behaviors (e.g. cell phone use/scrolling or lack of sleep) or other root causes (e.g. traumatic brain injury) and not true ADHD. Who is diagnosed with ADHD? Research is only recently evolving out of the realm of white males, and this is super important. For example, children of color, especially boys, are more likely to be diagnosed with Oppositional Defiant Disorder, where white children receive the ADHD diagnosis more often - but they present with the same symptoms. Updated research inspires more accurate diagnoses, allowing more appropriate interventions. The new research is also resulting in some diagnoses being made later in life. There has been an overall increase of one million diagnoses of ADHD since 2016. Children These days 5-10% of U.S. kids ages 3-17 are diagnosed with ADHD, and 40-60% of those children maintain it into adulthood. Adults 75% of adults now diagnosed did not have the diagnosis as a child. Only 11% of adults are receiving treatment for it. Girls and Women Girls and women typically present with distractibility and Inattentive Type vs Hyperactive, and this can cause their diagnosis to be missed altogether. It can make them feel stupid where they are actually just wired differently. Therefore, girls and women will establish coping strategies that mask their symptoms and allow them to be successful in spite of the struggle. But the struggle is real. To this point, here’s one surprise category of individuals that experience ADHD symptoms at an elevated rate: perimenopausal and menopausal women. In my clinic and by the reports of my colleagues, women often report a spike in symptoms of ADHD that can be prominent enough to warrant a new diagnosis. This is a result of the drop in estrogen that has a modulating effect on the brain areas of focus/attention, reward, motivation, and executive function. Likely these women have had ADHD their whole lives, but it was only in menopause that they no longer felt they could manage it well. Co-Occurring Conditions Children and adults with ADHD might experience co-occurring brain and mental health conditions (also called co-morbid). For me, the overlap between Autism Spectrum Disorder (ASD) and ADHD is especially fascinating. Not surprisingly given the challenges and brain wiring, anxiety and ADHD often walk hand in hand. Remember that 40-60% of children with ADHD maintain it into adulthood, and what you see in childhood will filter into adulthood. Here are the most prominent co-occurring diagnoses:  What are the roots of ADHD? ADHD, like many other illnesses, does not have a single root cause. Anyone with the diagnosis will need a complete evaluation to grasp the most likely contributing factors for their unique physiology and biochemistry. This will let the practitioner personalize interventions to be most effective. That said, common to those who suffer ADHD is that they have fewer dopamine receptors in the brain or may not be producing adequate dopamine at the right time, or both. Dopamine is the neurochemical of motivation, reward, focus, and attention. Interestingly, it’s also involved in physical movement. If it were a symphony conductor, dopamine would be assuring sounds and silences in the right moments of the music. Those with ADHD are hitting the notes and silences at the wrong time, which causes the “music” to become very confusing and out of sync with themselves and the world around them (credit to Andrew Huberman for the metaphor). The dopamine pathway can be disrupted by a number of things, and various contributors can trigger, worsen, or mimic ADHD symptoms:
Stay Tuned! Now that you know all about ADHD, come back in a couple of weeks when I publish my next Inner Workings! I will discuss assessments. I will follow that with non-medical interventions that can really support those with ADHD to function more successfully in their day to day lives.
|
AuthorI am Mary Virginia Coffman (I go by “Mary Virginia”), a clinical nutritionist who focuses on mental health, digestive health, metabolic health, and nervous system regulation. My unique combination of clinical interventions, education, and coaching will help you feel well in body, mind, and spirit. Categories |
RSS Feed