Case Study
Oligomeric Proanthocyanidins as an
Alternative Treatment for ADHD
Dr. James Greenblatt, M.D.
Attention Deficit Hyperactivity Disorder (ADHD) is
the most recent name for a complex neurobiological disorder that
occurs in children, adolescents, and adults. Symptoms include difficulty
with attention, concentration, memory, organization, and for some,
impulsivity, hyperactivity, aggressiveness, and relationship problems.
The scientific research has clearly documented that ADHD is a brain-based
disorder. There are many biological abnormalities in individuals
suffering with ADHD. It is a medical disorder that affects behavior;
it is not a “discipline problem.” Many untreated children
with ADHD develop oppositional behavior and become a “discipline
problem.” For some individuals, the right choice of medication
can be an invaluable asset in treatment. Unfortunately, medications
do not treat the biochemical or neurological imbalances underlying
ADHD and many medications have side effects. When individuals are
off medication the symptoms of ADHD return and frequently are worse
than before medication.
In our clinic, we have found numerous nutritional
and metabolic disturbances related to the symptoms of ADHD. Some
of these have been shown to contribute to behavioral and attention
problems, while others have not. We have found food allergies, heavy
metal toxicity, fatty acid imbalances, magnesium deficiencies, iron
deficiencies, zinc deficiencies, infections, dehydration, and carbohydrate
intolerance as underlying causes. Some individuals present with
only one of these metabolic disturbances while others may have two
or three. The only way to accurately determine individual nutritional
needs is with a detailed medical history and metabolic testing.
ADHD is not a simple disorder. Most individuals require
a multi-modal treatment plan that may incorporate dietary changes,
supplementation, behavioral therapy, and/or medication. Yet treatment
does not always need to be complex. Treatment that is simple enhances
patient compliance. When possible, we start patients on nutritional
supplements gradually. Such an approach allows us to clearly see
the results of supplementation. One supplement that has produced
positive results with many of our patients that suffer with ADHD
is OPC-Synergy™ (Standard Process Inc.).
AC
Female, 47 years of age
Case history: First consultation
AC presented for a psychiatric consultation for treatment
of Attention Deficit Hyperactivity Disorder (ADHD).
AC works full-time and actively takes care of her
health. She eats healthy, whole foods and exercises regularly. Although
physically healthy, she reported having problems with attention
and distraction from an early age. She abounds in tales of distraction
as a child: running down the aisles during church service, leaving
home without telling her mother, and difficulty focusing and completing
even the most basic tasks. Even today, her mother describes her
as creative, but restless, fidgety, and constantly on the go. Despite
problems with focus, AC was able to finish college.
AC is quite accident prone, having experienced several
car accidents, broken bones, and choosing partners who were volatile
and disruptive. Her son, age 11, also has difficulties with attention.
AC has made several attempts in the past to deal with
her difficulties in concentrating. A psychiatrist diagnosed her
with ADHD in 1994. She was put on Ritalin, but due to side effects
she stopped the medication. Like many adults with ADHD, she simply
resigned herself to living with poor attention and distractibility.
Her organization skills and strong will were invaluable assets that
helped her stay moderately focused and goal oriented.
Due to multiple stresses at home, AC’s difficulty
with inattention began to increase. Continually shifting from one
activity to another and excessive talking were not foreign to her,
but they now became a daily disruptive norm. In September of 2000
she again sought help, this time with me. At the time of her initial
assessment her primary complaints were:
- Foggy thinking
- Inability to focus for long
periods of time, and
- Feeling overwhelmed by work,
with difficulty sticking to one project
Laboratory tests (food allergy,
stool analysis, fatty acid analysis, and organic acid analysis)
did not reveal any significant metabolic disturbances or imbalances.
To establish a baseline from which we could quantitatively
measure progress, AC was given an electroencephalogram (EEG) prior
to supplementation.
EEG Assessment
The EEG is one of the only objective methods for measuring
changes in brain activity. We used a spectral analysis of the electrophysiological
output at a single, midline prefrontal location (the vertex) to
indicate effects in cortical arousal and cortical slowing. Monopolar
recordings were made using one active electrode and two ground electrodes
both before and after supplementation with OPC-Synergy™.
Brain waves are measured in hertz (Hz). Peaks at 14-18
Hz and 16-20 Hz have been associated with improved attention in
both children and adults.
Theta waves (slow waves; 4-8 Hz) associated with daydreaming,
are higher in individuals with ADHD. They are associated with inattention,
distractibility, disorganization, and poor task sequencing. Beta
waves (fast waves; 13-31 Hz) are associated with concentration and
are believed to be lower in individuals with ADHD. High beta activity
is associated with an ability to focus, organize, and pay attention.
ADHD subjects produce more theta activity and less beta activity
than controls matched for age and grade level (Mann et al., 1992).
It has recently been suggested that the only objective test for
diagnosing ADHD is the electrophysiological output (Pw) in the theta
frequency band divided by the output in the beta band, generating
a ratio of theta to beta activity. Higher ratios are associated
with ADHD.
Treatment
AC readily made many of the lifestyle recommendations
that we give to our ADHD clients. She went on a diet consisting
largely of whole foods, high in protein and low in carbohydrates.
She eliminated coffee and began drinking green tea instead. She
continued to take a multi-vitamin supplement daily.
Based on the fact that her lab tests were negative,
I decided to begin slowly supplementing AC with OPC Synergy™.
The starting dose was one pill on an empty stomach, before breakfast.
After four weeks she increased the dose to two pills in the morning
with breakfast.
Second consultation: 2 months
AC reported that within one month on OPC Synergy™
she had begun feeling “clearer,” with an increased ability
to retain her concentration over a long period of time. Prior to
her return visit, AC sent the clinic the following note:
“I am on the OPC Product…I just wanted to
let you know that I am noticing an incredible difference. I just
went down to a two-day sales meeting and I am off caffeine. It is
the first time I can remember ever being able to sit through an
entire day of meetings. Listening intently, not wandering off on
multiple tasks and ideas and not being tired! Totally focused!…Just
from being on that single pill….”
During her second consultation, AC mentioned that
she had sustained a head injury ten years ago, which required her
to be out of work for six months. She felt she had never been her
“real” self until after trying OPC Synergy™.
In addition to her reported improvement in symptoms
of ADHD, her EEG pattern also improved. Interest was focused upon
significant changes in the theta to beta ratio of the EEG. AC’s
EEG after supplementation exhibited a larger peak at 18 Hz as well
as a decrease in slow theta activity (associated with day dreaming,
sleep, and relaxation; Figure 1), thus lowering the theta to beta
ratio. This is what one would expect to see when attention has improved.
Additionally, the results of the EEG during performance of specific
tasks (baseline, reading, listening, and drawing) indicate that
she had a remarkable improvement in her ability to concentrate (Figure
2).
Autogenics EEG Assessment
Discussion
Oligomeric proanthocyanidins (OPCs) are one
class of flavonoids, a ubiquitous group of polyphenolic substances
that are present in most plants. OPCs have been isolated from many
plants including apples, berries, grapes, raspberries, and blackberries,
and they are also present in many red wines (Schwitters and Masquelier,
1995). Although OPCs were originally extracted form pine bark (pycnogenol),
this source is significantly more costly than extracts from other
plant materials. In my practice, I have found that patients taking
OPCs from multiple sources have more consistent responses.
How OPCs improve brain function and possibly
symptoms of ADHD is speculative. The simplest explanation may involve
the protective effects of proanthocyanidins on brain lipid peroxidation.
There are animal models that have demonstrated this effect with
grape seed extracts (Bagchi et al., 1998). Free radicals have been
implicated in a number of neuropsychiatric disease processes. The
brain may be particularly vulnerable to free radical damage because
neurons are so rich in docosahexaenoic acid (DHA), a highly polyunsaturated
fat.
Nutritional claims in the treatment of ADHD
have a long history of parents and professionals taking sides. Diet
fads and “alternative” therapies come and go as parents
desperately seek help. Testimonials regarding the benefits of OPC
in the treatment of ADHD are common in the lay press and on Internet
bulletin boards. A recent publication in the Journal of the American
Academy of Child and Adolescent Psychiatry described a case study
of a 10-year-old boy who demonstrated “significant improvement
in ADHD target symptoms within three weeks” after being treated
with OPCs (Heimann, 1999). In our clinic, we have recorded multiple
case studies demonstrating EEG changes, handwriting changes, improved
school performance, improved behavior, and improved computerized
continuance performance testing after supplementation with OPC (Greenblatt,
1999).
The psychiatric community is waiting for double-blind,
controlled studies before trying “alternative therapies”
like OPC. Yet the psychiatric community is also responsible for
prescribing multiple psychotropic medications to preschool children!
In one study in Michigan, over half the children under three years
of age diagnosed with ADHD were treated with medication, and over
33% of children received multiple medications.
There is no double-blind, placebo-controlled
study to support the use of psychotropic medication in three year
olds.
ADHD is a complex, multifaceted disorder that
disrupts psychosocial development and may have profound consequences
in every aspect of an individual’s life. OPCs are safe, naturally
occurring, non-toxic compounds without any documented side effects.
This case study is just one example of a documented correlation
of clinical improvement with objective laboratory findings. OPC
can be an effective biological alternative in the treatment of ADHD
in adults and children.
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