Why ADHD Is Not A Psychiatric Disorder Or Brain Disease with Dr. George Papaicolaou - Transcript

Dr. George Papanicolaou (00:00): And you can bring 10 kids in here with ADHD, or the label of ADHD, and each one of them is going to be treated differently because they're all going to be different. Their genetics are going to be different, their environments are going to be different, their supports are going to be different. Dr. Mark Hyman (00:18): Welcome to The Doctor's Farmacy. I'm Dr. Mark Hyman. That's Farmacy with an F, F-A-R-M-A-C-Y, a place for conversation that matters. If you have ADD or ADHD, or know someone, or have a kid who has it, this conversation's going to matter to you because it's a special episode of House Call with none other than Dr. George Papanicolaou, who's a colleague of mine here at the UltraWellness Center. Incredible physician, a rockstar in his own right, and we're going to get right into it because he and I have been dealing with these problems for decades and it's so prevalent, it's so common. I mean, one in 10 kids in America is on ADD medication. I mean, there was that one kid that I remember in my class, Patty, I remember his name, who was that troubled kid, but that was it. It wasn't like half the class on ADD medication. And then we have a whole slate of learning disabilities and we have autism and we have this one in six kids with a neurodevelopmental disorder. And it's not a Ritalin deficiency. Dr. Mark Hyman (01:13): So let's talk about ADHD. Why do we see this problem? What is ADHD? And, of course, it affects adults and kids, but kids, it really disturbs their lives. It impacts us so badly in terms of our ability to learn and focus and succeed in life. Some people with ADD do fine, I mean, I have a little bit of it, and I do okay- Dr. George Papanicolaou (01:33): I have a lot of it, personally, but- Dr. Mark Hyman (01:36): So there's a spectrum of how bad it is- Dr. George Papanicolaou (01:38): Yeah, Mark- Dr. Mark Hyman (01:39): ... but I can sit and I can read a whole book, and I can focus, I just get distracted. But I think we live in a very distracted world, and I think we have a nature deficit disorder, and I think we have a lot of reasons why we're seeing this, but what is going on that we see so much of this problem in America today, and around the world? Dr. George Papanicolaou (01:54): Mark, it's always a pleasure, and I love talking about these topics with you, because you're so well-versed. Actually, in preparation of this I went back and reviews the UltraMind Solution, and- Dr. Mark Hyman (02:04): You read my book? Dr. George Papanicolaou (02:05): I did. Dr. Mark Hyman (02:05): You prepared for the- Dr. George Papanicolaou (02:07): Well, it's important to know how you think. So, yeah, I did, and it just reminded me of so many of the important things that we need to think about when it comes to the brain. ADHD is one of the classic examples of how important it is to look at the whole picture. Now, in your intro you covered such important topics about ADHD, that I'm sure we'll get to most of them as we talk today. The thing with ADHD, first off and foremost, is it's primarily been looked at as a medical model. In the psychiatric world, it's a medical model, it's sometimes seen more as a behavioral issue, and it's treated with medication. Dr. Mark Hyman (02:53): It's a brain disease. Dr. George Papanicolaou (02:54): It's a brain disease, and as you said before, it's a body disease that affects the brain. Dr. Mark Hyman (03:01): Yeah. Dr. George Papanicolaou (03:02): And you've said that. Now, in ADHD, there are some issues around the brain itself that make adults and children more susceptible to this inattention, or their ability to fail at executive functioning. The other piece is the self-regulation piece, and so you have this combination ADHD where you have self-regulation is an issue, and you have the executive functions of an issue. Dr. George Papanicolaou (03:30): Now, it's been given this label, attention deficit hyperactivity disorder, and that's just a cluster of symptoms that everybody experiences to some degree in their lifetime. Now, there's one kid in kindergarten that maybe he didn't pay attention once in his lifetime. He's a spy, I don't know what he's doing, but he's doing something where you have to pay attention all the time. And then there's the other person who they're so disabled by their ADHD it's hard for them to work, it's hard for them to maintain a relationship and even marriages. And then everybody else falls somewhere in between. Dr. George Papanicolaou (04:07): And I think it's important to understand that piece, that it's a medical model, and that when we see kids and adults the other piece is that more and more adults are being diagnosed, and at least 4% of adults are found to have ADHD and maybe even more. I think we'll found out there's more as we go on. That they carry on the traits or the ADHD, they go undiagnosed, and then as they're adults it becomes more prevalent as life piles up and their compensatory mechanisms become overwhelmed, and they're getting older, and they're not eating right, and they're not exercising, their ADHD becomes more prominent, and then they come seeking help. Dr. Mark Hyman (04:50): And on top of that, we live in an ADHD culture where we're all driven to consume huge amounts of information by the addictive nature of social media and the internet, and it literally is taking people who are not even ADHD and making them like that where they're hooked on their phones and they're constantly distracted and they're constantly getting the dopamine hit and it's magnifying it, and if you have ADHD it's just even worse. Dr. George Papanicolaou (05:16): Yeah. And here's how they come to us, they come to us as families, as a mom or a dad bringing a kid in and they're discouraged, they're frustrated, the child is feeling left out, he's feeling alone, because he's being labeled as a behavior disorder, he is unable to keep up in the regular curriculum in the school where you have to sit and get. And he can't sit and get. He has to move around, he has to see pictures, he has to have creative illustrations, or she. And that's how they come to us and they've heard, "Johnny's so smart, if he'd only work harder. Suzy, if she would just apply herself. Sometimes I think she's a little bit lazy." And they start to hear that language and then they start to inculcate that as their own identity, and that becomes a negative self talk, that becomes discouragement, that becomes hopelessness for some people as time goes on. Dr. Mark Hyman (06:15): Yeah. It's seen as a psychiatric disorder, treated by psychiatrists, and maybe it isn't really a psychiatric disorder. Dr. George Papanicolaou (06:23): It's not. Dr. Mark Hyman (06:24): In fact, most psychiatrist disorders are not psychiatric disorders, that's why I wrote the book UltraMind Solution. Dr. George Papanicolaou (06:28): Yeah, right. Exactly, you just said it in that book. Dr. Mark Hyman (06:31): Right because the body affects the brain and the brain affects the body. The mind affects body, but the body affects the mind. And I think the cure for brain disorders is often outside the brain and I think that's what we're talking about here and now it's actually becoming part of conventional medicine. I recently interviewed for our podcast an expert in nutritional psychiatry and the microbiome in psychiatry from Harvard, another one who is in Stanford studying metabolic psychiatry. Dr. Mark Hyman (06:58): So we now know that there are so many factors influencing our brain function that have been ignored by psychiatrists and they're using psychiatric drugs like stimulants, like Ritalin, to help people focus, but it's just like pouring water on a fire with somebody else pouring gasoline on it at the same time. You have to get to the root causes. Dr. George Papanicolaou (07:22): Right. And I know we're going to get to the root causes, but one of the things I just really wanted to mention is in that discouragement that parents come and they're worried about their child's performance, and even adults who now have piled up failure after failure after failure because of their inability to really deal with their ADHD and they didn't even know they had it. Dr. George Papanicolaou (07:46): I had a patient, she was 40 years old, she came to me because she saw one of my nurse practitioners, and my nurse practitioner said, "She wants a refill on her Ativan, but I'm uncomfortable giving to her," because she was a new nurse practitioner. I said, "Well, let me see the case," I saw the name of the patient, I saw that they were coming to get their Ativan again and they had a gap of using it, so I said, "You know what, schedule her with me." And she said, "you know, I use it because I get overwhelmed," I said, "What do you mean overwhelmed?" Dr. Mark Hyman (08:15): So it's an anxiety medication. Dr. George Papanicolaou (08:17): She takes it because she gets anxious and overwhelmed and I said, "Well, what do you mean?" "Well, I get anxious," "Well, what do mean by anxious?" "I get overwhelmed," "What does overwhelmed mean?" And she started to describe all the symptoms of ADHD, and she's a teacher. She was 40 years old. I took her through the DSM4 classification and then she went on to get a diagnosis. Dr. Mark Hyman (08:36): That's a psychiatric manual for how we label people with different mental illnesses by symptoms. Dr. George Papanicolaou (08:42): How we label people. Yeah, I used it. I did use it, I'm sorry, but I had to. Dr. Mark Hyman (08:43): Well, it's good. It's good to get a label. But I always say, just because you have a label doesn't mean you know what's wrong with you, you don't know the cause of your depression or ADD or whatever is going on. Dr. George Papanicolaou (08:51): So I told her, we did it, I said, "You have ADHD." She was devastated, she was truly devastated, and she came back in tears because, one, all the regrets, "Why didn't I get diagnosed sooner?" And then the denial, "Maybe I don't really have it, maybe there's something else wrong that can be fixed easier." Anyhow, it's like now eight years later and I run into her, because we're friends, and she got an ADHD code, she did take Adderall for a short period of time, I got her to work on her nutrition, so forth, she's doing amazingly well. Dr. Mark Hyman (09:24): Amazing. Dr. George Papanicolaou (09:25): Amazingly well. But the point I want to make, is that ADHD can be a really devastating experience and one of the things that I like to do when I'm working with my patients, this is the first thing we do, we've got to normalize it. We've got to let you know, "Everything's going to be okay." Dr. Mark Hyman (09:43): Well, that's right. There's a stigma, George, around mental illness and that's really why I wrote the book UltraMind Solution because it was very clear to me seeing patients who I would treat their biology and their psychology would get better. Dr. George Papanicolaou (09:56): That's great. Dr. Mark Hyman (09:57): And I wasn't treating their brain, I was treating their body, and I would notice the "side effects" of their ADD going away, their autism getting better, their depression going away, their panic attacks going away. I'm like, "What is going on here?" So that really through the lens of functional medicine, what we do here at the UltraWellness Center in Lenox in Massachusets where we practice, is we go deep into these root causes. So with ADHD, what are the things that are the most common drivers? Because it's not a Ritalin deficiency as we said. It's something else. What are we seeing in these patients that we find that then we can treat and help them get better? Dr. George Papanicolaou (10:36): I start with the understanding that there are some structural differences in the brains of a person with ADHD. Dr. Mark Hyman (10:48): There's a predisposition. Dr. George Papanicolaou (10:48): Yeah, there's a predisposition, it's genetic, it's physiologic, so you can't ignore that starting point. That's my first line of thinking, and I know that I'm going to find out what that is. Dr. Mark Hyman (11:05): It's important to remember to people that genes load the gun, but the environment pulls the trigger. Dr. George Papanicolaou (11:10): Exactly. Dr. Mark Hyman (11:11): So you might have a predisposition, it doesn't mean you're predestined to have the problem. Dr. George Papanicolaou (11:14): Exactly. And that's exactly right, Mark, and that's where I go next is I know the predisposition's there and I have tests that I can figure out what some of those predispositions are actually expressing themselves in that child or adult and I will address. But I also, as you just pointed out, is I go back to the environmental pieces first because those I can start working on at the very first visit. Dr. Mark Hyman (11:39): You can modify. Dr. George Papanicolaou (11:40): Modify at the very first visit without having to do any tests. And that is to go through lifestyle. And where is the first lifestyle piece I go to? It's nutrition. Because the nutrition does a couple things. There's the nutrition, the actual macro, micro nutrients and minerals and phytonutrients that the child needs that they might not be getting and then there's the impact that that diet he's on is having on his body, and particularly on the gut micro biome. Dr. Mark Hyman (12:11): On the bad diet that they're on. Dr. George Papanicolaou (12:13): Right, the bad diet which is filled with all the things that you talk about all the time. The high fructose corn syrup, the GMOs, the hormones, the pesticides. Dr. Mark Hyman (12:23): The additives and colors and dyes. Those chemicals have been linked in research to ADHD issues, really clearly. Dr. George Papanicolaou (12:28): Absolutely. And there's a diet, the Feingold diet, is based on removing those from the diet. So I can modify that right off the get go and I can get them to start to think about how to change that child's diet and simply remove some things and add some things in their place to start moving them in the right direction. Dr. Mark Hyman (12:51): And the diet you're talking about that they're getting usually is an inflammatory diet. Dr. George Papanicolaou (12:54): Yes. Dr. Mark Hyman (12:55): And what's fascinating to me, as we start to look at the research on all these brain issues, whether it's autism, or ADHD or Alzheimer's or depression, they're inflammation in the brain. Dr. George Papanicolaou (13:05): Yep. Dr. Mark Hyman (13:06): And we never knew that before. So do you take an Advil if you have depression or if you have ADD? No, you have to figure out why there's inflammation in the brain, and that's what functional medicine does. It's a methodology to get to the root cause of whatever it is, and in this case it's inflammation in the brain. And all these kids often have other inflammatory issues too, and you have a case and I want to share a case where we talk about this. But how do we begin to tease apart what aspects of the diet are the most important in these kids? Dr. George Papanicolaou (13:37): First I interview, I ask. To tease it apart you have to ask- Dr. Mark Hyman (13:42): What are you eating or not eating? Dr. George Papanicolaou (13:42): "Mom, what are you feeding?" And I'll ask them. And as soon I ask the child what they eat, here's what happens, I'm going to just pick this up. Mom's holding a folder or a newspaper or something and I ask the child what they're going to eat I see this. She's going to hide because she knows what's going to come out. We're going to hear about Lucky Charms and we're going to hear about hot pockets and we're going to hear about the Gatorade. Dr. Mark Hyman (14:09): Flaming Hot chips. Dr. George Papanicolaou (14:10): And she feeds the child that because that's what the child wants to eat and because they can't self regulate she knows that there's hell to pay when you're not giving them what they want. So first off, you tease it out by doing 3-day diet history, talking to the mom, talking to the child. And once you begin to tease that out, then you can get an understanding of what you need to add back in. And most of the time it's like everything. Dr. Mark Hyman (14:40): We also do food sensitivity testing, checking for gluten and dairy which often causes inflammation in the brain for these kids. Dr. George Papanicolaou (14:46): Yeah. I don't know when you want me to talk about the testing piece, but the thing I want to say about the microbiome in your diet is that inflammatory diet, remember, for our listeners that the gut microbiome does things for us. It's like another organ. 70% of our serotonin resides in the gastrointestinal tract. Dr. Mark Hyman (15:12): Like a second brain. Dr. George Papanicolaou (15:13): Right, the second brain. 30% of our dopamine resides in the intestinal tract. When you're eating a bad diet and you're shifting the microbiome, you're shifting the balance of good bacteria and bad bacteria, you're now going to create an environment where a child cannot produce some of those neurotransmitters, you're going to create an environment where they're not breaking down their food completely, because of the inflammation you could be getting something called leaky gut and that dysbiosis, that leaky gut, that leads to a lack of absorption of some really important nutrients, and that begins to have a big effect. Dr. George Papanicolaou (15:55): So now, they're not absorbing their magnesium, now they're letting too copper in and not enough zinc, now you're not getting enough iron, and we know that if you're anemic and you don't have enough iron you're not going to be able to concentrate well. That's the real important impact of your diet. It's not just, "Oh, sugar's bad for them." Well, what's it doing to- Dr. Mark Hyman (16:20): The microbiome. Dr. George Papanicolaou (16:21): The microbiome. We got to fix that. And that's why I said, I know what the predisposition is, but the first place we're going to go is to the lifestyle because that lifestyle's affecting the most important thing and that's the gut. Dr. Mark Hyman (16:31): Yeah, nutrition is so huge and we see this with these kids is that they have poor quality nutrition, they're eating a lot of processed food, they're not getting that good nutrients they need, they're eating foods that are inflammatory, they're having gluten and dairy often which can be very neuro toxic for some kids, they're eating additives and chemicals in their food that can trigger hyperactivity. And so there's this whole range of food interventions that have been shown to be very effective for these, because even removing food sensitives, as one study published in the UK. So there's a lot of literature on this, but again, it's not something you get when you go to the psychiatrist- Dr. George Papanicolaou (17:04): It's not mainstream. Dr. Mark Hyman (17:05): No, they don't talk about this. Dr. Mark Hyman (17:06): Hey, everybody. It's Dr. Hyman. Thanks for tuning in to The Doctor's Farmacy. I hope you're loving this podcast. It's one of my favorite things to do and introduce to you all the experts that I know and I love and that I've learnt so much from. Dr. Mark Hyman (17:17): And I want to tell you about something else I'm doing which is called Mark's Picks, it's my weekly newsletter and in it I share my favorite stuff. From foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use, and that my team uses, to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter, I'll only send it to you once a week on Fridays, nothing else I promise. All you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger, longer. Now, back to this week's episode. Dr. Mark Hyman (18:01): So we're looking at the role of nutrition, nutritional deficiencies, food sensitivities, and lack of the right nutrients. What are the other things we should think about? The gut you said, the gut plays a huge role, right? Dr. George Papanicolaou (18:13): Yeah, yeah. Dr. Mark Hyman (18:14): Leaky gut. Dr. George Papanicolaou (18:16): Yeah, everything I just mentioned. With the leaky gut, the alterations in the microbiome, you're going to have less serotonin made, less dopamine made, you're not going to get the nutrients that we just talked about. And so we look there and we can do tests to determine. We have very sensitive tests, we do organic acid tests that can look at amino acid levels, which are the precursors for making your neurotransmitters. So that if you're not eating enough protein, which kids don't eat enough protein, eating enough protein, and then you've already disordered your microbiome, which includes your gastric acids, which includes your pancreatic acids. This is very important for breaking down your proteins, your carbohydrates and your fats. You get all the nutrients you need. Dr. George Papanicolaou (19:03): So we need to make sure that if that's not happening, they're not getting their amino acids, then they're not going to be able to make these neurotransmitters. We can measure that. These organic acids. We can look at carbohydrate metabolism that's important in energy production, energy that's needed for the body to work, particularly the brain since it has the most mitochondria in the entire body because it needs the most energy, and if that brain's not making energy because you're not getting the appropriate amounts and the types of carbohydrates, that child's not going to do well. And we can determine that on the organic acids or an ion profile. Dr. Mark Hyman (19:40): These are kind of tests you don't normally get at your regular doctor, and these tests tell us about things like mitochondria. You mentioned mitochondria, I just want to loop back on this because there's a woman named [Suzanna Goza 00:19:51], a pediatric neurologist, went to Harvard and Oxford and studies autism, and she's found in these autistic kids there's a subset of these kids that have impaired mitochondrial function in their brain. And it's an energy deficit which can cause these neurologic symptoms. So she provides the substrates, or the basic building blocks for making energy in these kids that are supplements, like CoQ10 and carnitine and other nutrients that are so important for building energy in this system. So we sometimes find this in these kids, they have energy issues. Dr. George Papanicolaou (20:25): Absolutely. You know we've seen that with our autistic kids, we give them amino acids, when we give them methylcobalamin, which is a basic nutrient, you see changes in how they- Dr. Mark Hyman (20:37): Dramatic changes. Dr. George Papanicolaou (20:38): Dramatic. When you address the mitochondria, you're going to see those dramatic changes. Dr. Mark Hyman (20:42): And they also have issues around toxins, these kids sometimes. So talk about toxins and mental health and particularly ADHD. Dr. George Papanicolaou (20:51): Right. So the toxins that we look for the most, and they're tested for in schools as part of your- Dr. Mark Hyman (21:00): In lead. Dr. George Papanicolaou (21:01): Lead. There you go, got lead. So we have lead, but we also have mercury and we have arsenic. Those are three very common heavy metals that you're going to find in your environment. So those, each one of them, are going to be able to block the energy producing pathways in cells, they're also going to limit the metabolism neurotransmitters in the brain, directly. They're directly neurotoxic and they also have effects on the body's ability to make energy in your mitochondria. So we test for heavy metals in kids all the time. Dr. Mark Hyman (21:41): Yeah, surprisingly you'll find them. Dr. George Papanicolaou (21:43): And why do we find that? Because, I tell people, it's not a matter of whether you're toxic, it's not a matter of whether you have heavy metals, it's how many do you have, and how much. And that's going to be a product of several things. One, we go back to genetics. You just may not be a good detoxer, you may have SNIPs, which are single-nucleotide polymorphisms, those are like one single nucleotide change in the blueprint that makes the protein. And if that is off, then that protein is not going to work correctly. Well, if your detox proteins and enzymes are not working, you just don't detox that well. And we can determine that. And then we can determine what your lead levels are and then we have ways that we can bring those down. Dr. Mark Hyman (22:30): And it's so common. I remember this kid I had who was like 10, 11 years old, just a terror. ADD, getting kicked out of class, disruptive, behavior issues, and the mother was just desperate- Dr. George Papanicolaou (22:41): I wasn't in your class. Dr. Mark Hyman (22:44): She was a young mother, but she was very smart and she came to us and it turned out his school was across the street from a cement plant, and the cement plant burns coal and coal releases mercury and lead. And every day they'd go in the parking lot at the end of the day, the car's were just dusted with this ash from the cement plant. And the kids were playing in the playground with the cement plant. And I tested him and he had very high levels of heavy metals. And we detoxed [inaudible 00:23:10], we fixed his metabolic pathways, and this kid got better. Dr. Mark Hyman (23:14): So it's not that every kid with ADD has lead or mercury, it's just one of the things to think. Like I always say with functional medicine, just because you know the name of the disease doesn't mean you know what's wrong with you. ADD can be many, many things and many, many factors. Could be gluten, could be metals, could be nutritional deficiency, could be magnesium issues, can be your gut microbiome, can be gluten. So you have to think about all the factors. And that's really what we do and we have very specific tests which we can do to identify this in functional medicine. Dr. George Papanicolaou (23:41): And you can bring 10 kids in here with ADHD, or the label of ADHD, and each one of them is going to be treated differently because they're all going to be different. Their genetics are going to be different, their environments are going to be different, their supports are going to be different, and that's what we do in functional medicine. When a child or an adult comes to me I spend up to 90 minutes just teasing out every piece of the puzzle I just talked about. Dr. Mark Hyman (24:08): So tell us about Joey, because he's one of your patients. Dr. George Papanicolaou (24:10): Joey. So Joey came to see me and there's a multitude of issues. The one that was the main presenting issue was the fact that he wasn't doing good in school, he as told he had ADHD, and the mom and the dad had taken him to the primary and the immediate desire of the primary care physician was to start him on a stimulant. Dr. Mark Hyman (24:38): Like Ritalin. Dr. George Papanicolaou (24:38): Like Ritalin, Adderall, and such. And they just didn't want to go down that road. They had heard a podcast, they'd read one of my blogs, and they decided to come to the UltraWellness Center, here he comes. So going through the entire history with Joey we found out that Joey, a very early time in his childhood, he had had gut issues and he had eczema early on in his life. So what were those gut issues? Lots of colic, dairy sensitivity, and eczema. These sort of resolved a little bit as time went on and he developed some seasonal allergies and then he developed the ADHD. Dr. George Papanicolaou (25:18): So he was being treated with antihistamines during spring time, they cut back dairy, and that was it. So Joey comes, lovely kid, very bright, and quite honestly his behavior in the room wasn't as off the wall as some of the kids can be. And when I did ask him questions he could articulate pretty clearly. I could seem him start to- Dr. Mark Hyman (25:49): Fidgeting. Dr. George Papanicolaou (25:49): Yeah, he was starting to fidget as time was going on, but I think his dad was fidgeting more than him. This is very inheritable. So what did I do? The same things that we always do. I did his genetic testing, so we do a test called DNA Health, and that lets us know about several know about several important genes, I can learn about those detox genes I talked about, but then I also can look at some of the methylation genes, and again in your UltraMind Solution you do a great job in explaining methylation. Methylation is a process that the body uses in thousands of reactions to activate molecules to do their job. Dr. Mark Hyman (26:31): It's like one of the most important chemical reactions that happens literally millions of times a second. Dr. George Papanicolaou (26:36): Yeah, million times a second. It's protecting and repairing your DNA, it's part of the detox pathways, and it's really important in neurotransmitter metabolism. So two of them, one called the MTHFR gene and one called the COMT gene, really control methylation. And the COMT gene in particular is responsible for metabolizing the catechol neurotransmitters. Dopamine, norepinephrine and epinephrine. Those are the three neurotransmitters in the prefrontal cortex, so the frontal lobe, that are responsible for behavior, executive function, self regulation, concentration and learning, in the prefrontal cortex. Dr. Mark Hyman (27:20): And these are just variations in our genes that aren't a mutation per se, they're just differences among individuals that make more or less likely to have a different issue. Dr. George Papanicolaou (27:30): Yeah, they're the genes that give you blue eyes, give me brown eyes. But they also are responsible for some really critical life altering reactions in our body. Dr. Mark Hyman (27:43): In fact, one third of our entire DNA codes for enzymes, which regulate most of our body functions and those enzymes are all controlled by nutrients and when you have variations in those enzymes you may need higher amounts of certain nutrients. So while 400 mcg of folate might be good for one person, another person might need 4,000. Dr. George Papanicolaou (28:06): Yeah, absolutely. So I checked the genetics and I found that he had a variation in his COMT gene that actually left him with really low levels of dopamine, so at baseline he had low levels of dopamine. Dr. Mark Hyman (28:22): Which is what makes you focus and pay attention and be alert. Dr. George Papanicolaou (28:26): Yep. And so, interestingly enough, when you take that child and you put them under pressure they actually function better because now their dopamine levels start to come up under pressure. Dr. Mark Hyman (28:41): Is that why I always do better writing my books under deadline? Dr. George Papanicolaou (28:42): Yep, yep. So there's this thought that I've had that kids procrastinate and adults procrastinate so they find themselves under pressure because now their dopamine levels go up and now they're in the sweet spot and they can get their work done. So I found that he had that particular gene. And of course, I've already talked about what the worst diet could look like, well, he had the worst diet. We did an ion profile and we found that he was missing important nutrients, he was low in his B12, his B2, riboflavin was low. Dr. Mark Hyman (29:26): It's important for energy production. Dr. George Papanicolaou (29:28): Right, energy production. That's the mitochondrial cellular activity that provides the energy for your neurons to work, and he was low in his B vitamins and that's really critical. Folate was normal, but his MTHFR gene had a variant that made it less active. Why is that important? Because the MTHFR gene is responsible for methylating folate. Dr. Mark Hyman (29:55): That makes it active so the body can use. Dr. George Papanicolaou (29:57): That makes it active. If you don't have active folate you can't use it, and folate is a very big important part of how your neurotransmitters and your brain's going to work. So he had two genetic issues, a poor diet, and he had an imbalance in his gut. He had just general dysbiosis, an overgrowth of a lot of bad bacteria. And so I treated those things. Dr. George Papanicolaou (30:22): How do I treat that? They meet with our nutritionist and the first thing we do is we put them on an elimination diet. We take out all the bad things. So we're taking out sugar, we're taking out processed carbohydrates, we're taking out foods with coloring, we're taking out dairy, gluten, soy. And I can just tell you, when I met with Joey six weeks later, just based on the nutritional changes that I made, before I had my lab results, we started him on that diet, before the lab results came in, mom was already talking about how his attention had improved. Dr. George Papanicolaou (31:05): Now, I had added some magnesium in the first visit, I added some fish oil, there are studies that show that children with ADHD when they get at least 4 grams of omega-3s daily you see an improvement in their executive function, you see an improvement in their behavior. So I put him on fish oil, magnesium, vitamin D, that diet, by the first visit back mom was already saying, "Teachers are seeing a difference," and that she was noticing a difference too. And he was sleeping better. Dr. Mark Hyman (31:35): That's amazing. Yeah, that's so great. And you see these changes in these kids where they've been struggling for so long and it's just heartbreaking to see what it does to the families, the kid's self esteem, the kid gets picked on or doesn't do well in school. These consequences of these problems are enormous for people and they're not that hard to fix often. Dr. Mark Hyman (31:52): And it just reminded me of a case I just want to share briefly of Clayton, who came to me at 12 years old. His mom was really struggling with him, very disruptive behavior, he had ADD since he was in kindergarten, he was kicked out of kindergarten, on and off Ritalin, and struggled. Not doing well in school. And he also had all these other issues and what happens is this silo effect in medicine where the psychiatrist treats the ADD and then there's all these other problems a kid has. He had asthma, he had eczema, he had irritable bowel, he had headaches, he had anxiety, he had anal itching, he had allergies, he had trouble sleeping. He had all these issues, he had muscle cramps and twitching. Dr. Mark Hyman (32:38): And when I looked at his full history I'm like, he's got an overwhelming amount of inflammation, all these problems are inflammatory issues. And it was so related to the inflammation in his brain. And so what I did was I did a workup on him and I found his diet was terrible, he only ate junk food, never ate a vegetable in his life, processed food all the time, he was treated by seven different doctors on seven different medications, no one said, "How is this all connected?" They're all siloed. Dr. Mark Hyman (33:08): And I started to dig deep and I did the tests we do here in functional medicine. I did nutritional profiles, I looked at all things you mentioned. Amino acids, organic acids, minerals, vitamins, antioxidants. And I looked at his stool test, I looked at heavy metals and I looked at food sensitives, and I looked at all these factors and it was just fascinating because even by his history I could predict what he had on his test because he didn't eat any real food. Dr. Mark Hyman (33:35): So he had no omega-3 fats, he had extremely low levels of magnesium, which comes from wholefoods and grains and beans, he had extremely low levels of zinc, which again comes from good food, he had low levels of B6 which is important also for neurotransmitters and folate, and he had all these other issues that were also going on. He had a little bit of lead in his system, which can cause behavior issues, he had a leaky gut and he had overgrowth of yeast from lots of antibiotics. Dr. Mark Hyman (34:03): So I basically cleaned up his gut, I got rid of the bad stuff, put in the good stuff, did the elimination diet, add in all the nutrients that he was missing through supplements and I got rid of the heavy metals and we did a gut healing program on him, which is very simple stuff. And his mother brought him back two months later, not only was his ADD completely gone, all those other problems were gone, and what was really striking to me, hopefully we can put it in the show notes here for the podcast, his handwriting sample when he came in was illegible. Dr. Mark Hyman (34:37): A lot of these kids have ADD or autism have what we call dysgraphia, which means their penmanship sucks and you can't read their handwriting, 12 years old, he couldn't write within the lines, it was all over the place, it was illegible, two months later mom brings his homework back, perfect penmanship. And I'm like, "Holy crap, what happened here?" And I went, "How did his brain go from incoherent and dyssynchronous and chaotic to chaotic and synchronous and functional?" Dr. George Papanicolaou (35:03): It wasn't because you gave him Adderall. Dr. Mark Hyman (35:05): I didn't give him Adderall, I fixed the inflammation, I fixed his gut, I got his diet cleaned up, I gave him the nutrients his brain was missing, I changed his brain function in a way that was just so dramatic. And this kid then went on to become a astrophysicist. Dr. George Papanicolaou (35:21): Oh wow. Dr. Mark Hyman (35:22): And I was like, "Whoa, this is amazing." I wrote about it in the UltraMind Solution, but one of those stories that just sticks in your brain. Because when you see people get better they go, "I feel better, I'm focusing better. Okay, I feel better," is one thing, but when you see the handwriting sample you go, "Wait a minute, what happened here?" And I think this is what we see in these kids and we see the same case along the whole spectrum. Autism, ADD, I think it's just a spectrum of dysfunction in the brain and inflammation. Dr. George Papanicolaou (35:45): It is, it is. And it's getting granular and really getting into the, "Don't guess, test." Test and test until you get to the most granular level or you get to the root cause. To Joey I added tyrosine because his COMT left him unable to have enough dopamine in his brain. Dr. Mark Hyman (36:09): So tyrosine is an amino acid you make dopamine from. Dr. George Papanicolaou (36:12): Exactly. I gave him tyrosine at his second visit and that changed everything. That was like his brain started functioning at a really high level. Now, he came back third visit, this was like a year later, and still struggling though with just anxiety and still some sleep issues, and still having a hard time with organizing himself. And that's the other piece I tell people. There are just some habits, some skills, that still may be hard even though we get the brain functioning. Now we have the brain functioning at a high level and it's able to start to take in, rewire, it's plastic, and so now after years of being totally disorganized and chaotic, he's 13 years old- Dr. Mark Hyman (37:11): We have to learn those things. Dr. George Papanicolaou (37:12): He has to learn that all over. There are some things that you can do, so I had him start working with the ADHD coach that would teach him how to use a task list, how to use a calendar, set up cues so he can figure out when he's procrastinating. So that began to make a big difference. So mom then sent me, texted me actually, a picture of Joey at his desk... Well, he wasn't at his desk, but on his desk was a task list and a calendar with boxes checked off. And then she said, "I would never have imagined that two years ago Joey would ever been able to do this," and he was doing great in school. So it's not just- Dr. Mark Hyman (38:00): And all these kids Rip Van Winkle, they've been in the ADD zone so long they're kind of not functional and they don't learn the basic skills or the emotional or intellectual development that allows them to function at a higher level, so they have to literally learn that once their brain comes back online. Dr. George Papanicolaou (38:14): Yeah, I didn't do this with Joey, but I've been doing this a lot with my patients recently and that is getting them to meditate. Meditating, as you know, calms the brain and it changes the neurologic functioning of the brain. It's going to increase the size of your hippocampus, which is your memory center, it's going to increase the size of the corpus callosum which attaches right brain to left brain so that you can have your calculations and your creativity feeding each other back and forth, so you become even more creative. It's actually going to shrink down the amygdala, and that's the area of agitation and irritation and anger, that shrinks down, you get more self control. Dr. George Papanicolaou (38:59): So meditation is something I really recommend for adults and kids with ADHD. Dr. Mark Hyman (39:03): Yeah, so powerful. Dr. George Papanicolaou (39:04): Yeah, it's really powerful. Dr. Mark Hyman (39:05): George, this is an incredible discussion. We really have it all wrong when it comes to ADHD in this country. We're focusing on it as a brain issue instead of a body issue and we're missing all the real causes, which is our diet, not only the chemicals but the gluten and dairy, the processed food, the lack of good foods and nutrition, the damage of our microbiome, the toxins that can be there, and the other factors which we look at at the UltraWellness Center which is very different than most people do. And we see incredible results, sometimes there's a little harder, challenging cases, but we really see people get better. Dr. Mark Hyman (39:37): And for people listening out there, if you have somebody with ADHD in your family or you have it, try an elimination diet, try to take a basic multi, fish oil, magnesium and vitamin D, and see how that goes. Because that alone can help a lot of people. Dr. George Papanicolaou (39:51): Absolutely. Dr. Mark Hyman (39:51): And if you get stuck you can come see us here, we're here, and we have an incredible group of physicians who probably have over 70 years of functional medicine, more than any in the country I think, and we take care of people from all over the world and now we have remote virtual visits and consults. Dr. George Papanicolaou (40:05): Which have been great. Dr. Mark Hyman (40:06): Great, they're fun, you get to connect with us, and you can find us on the web at ultrawellnesscenter.com. I encourage you to check us out. And don't despair because there is hope and we need to sometimes do other things besides what we talked about, like limit devices and get out in nature. Dr. George Papanicolaou (40:23): I was about to say, I was going to- Dr. Mark Hyman (40:24): Those are also important aspects, I don't want to underemphasize. But that's another podcast. Dr. George Papanicolaou (40:29): That's another podcast. Dr. Mark Hyman (40:30): So George, thank you so much for being on The Doctor's Farmacy. Dr. George Papanicolaou (40:33): It was a great pleasure. Dr. Mark Hyman (40:34): And if you love this podcast please share with your friends and family and social media. If you've suffered from ADD or know anybody who has and you've learned some things about how to help yourself, please share it on comments. We'd love to hear from you. And subscribe wherever you get your podcasts and we'd love to see you next time on The Doctor's Farmacy next week.