J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 38:10,
OCTOBER 1999
To The Editor:
I read with great interest Dr.
Heimann’s letter (1999) on pycnogenol in the treatment
of attention-deficit hyperactivity disorder (ADHD). I have treated
more than one hundred patients with ADHD, using nutritional supplements
similar to pycnogenol (pine bark extract). His letter prompted me
to share my experiences with your readers; I hope this letter will
further discussion.
The biologically active compounds found in pycnogenol
are oligomeric proanthacyanidins (OPCs). The use of OPCs for the
treatment of ADHD has been circulating among parent groups, multilevel
marketing companies, and Internet groups for at least 6 years. I
became interested in these compounds after a treatment resistant
patient showed significant improvement without medications. Over
the past 4 years I have recorded case studies demonstrating (1)
EEG changes, (2) handwriting improvement, (3) improved school performance
and (4) continuous performance testing improvements. Family reports
have ranged from no change to dramatic changes. There are few side
effects of OPCs, although some children become irritable and have
decreased energy. I have found the most significant improvement
noted by patients are in areas relating to sustained attention and
distractibility, rather than hyperactivity and impulsivity.
OPCs are one class of Flavanoids. Flavanoids are a
ubiquitous group of polyphenolic substances which are present in
most plants. OPCs have been isolated from many plants including
apples, berries, grapes, raspberries and blackberries, and are also
present in many red wines (Schwitters and Masquelier, 1995). Although
OPCs were originally extracted from pine bark, pine bark (pycnogenol)
is significantly more costly than extracts from other plant materials.
In my practice I have found that patients taking grape seed extract
or OPCs from many different 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 disease processes including asthma, cancer,
cardiovascular diseases, cataracts, diabetes, macular degeneration,
Parkinson disease, and many other inflammatory processes. The brain
may be particularly vulnerable to free radical damage because neurons
are so rich in docosahexaenoic acid (DHA), a highly polyunsaturated
fat. Unfortunately, as Dr. Heimann pointed out in his letter, there
are not any published studies of ADHD and OPC, either alone or combined
with other treatment strategies.
There is a rapidly expanding body of literature on
nutrition and brain function. The research is embedded in non-clinical
journals and headlines are quickly picked up by the unregulated
health food industry. Hence, the “miracle cure” of the
week is discovered. 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. Nutritional biochemistry and the understanding
of cellular metabolism is not alternative medicine, but the foundation
for health and all disease processes. Medicine has slowly embraced
nutritional research. Psychiatry has lagged far behind. The benefits
of nutritional supplementation have quietly penetrated such conservative
medical publications as the New England Journal of Medicine (Oakley,
1998).
Diet has been associated with many major chronic illnesses.
The research is quite clear that lifestyle choices including dietary
habits affect our genetic potential. Many of my colleagues dismiss
the role of nutrition in ADHD, quoting old negative studies on food
additives, sugar, and megavitamin therapy. A 1997 study published
in Pediatrics found only 1% of children and adolescents met recommended
dietary allowances, with 50% of daily calories from fat and sugar
(Munoz et al., 1997). A study published in this Journal found that
food insufficiency and hunger are associated with poor behavioral
and academic functioning (Murphy et al., 1998). Is it such a leap
of scientific faith to surmise that the incredibly complex neurochemistry
that controls our ability to pay attention may need a sufficient
supply of nutrients for optimal functioning?
ADHD is a complex, multifaceted disorder that disrupts
psychosocial development and may have profound consequences in every
aspect of a child’s life. Understanding ADHD as a genetic neurobiological
disorder or “chemical imbalance” might provide an explanation
for parents giving their children psychotropic medications, but
it does not explain the tremendous variability of symptoms, nor
the treatment success many of us have had with OPCs and other nutritional
interventions.
In my psychopharmacology practice, I have had clinical
success in treating children and adults with ADHD utilizing OPC,
adjusting protein-carbohydrate ratios, and supplementing with trace
minerals and specific fatty acids based on a detailed red blood
cell membrane analysis from Kennedy Krieger Institute in Baltimore.
OPCs are safe, naturally occurring, nontoxic compounds that might
cost families a few cents a day. Clinical trials are desperately
needed to begin a scientific understanding of these exciting case
studies. I hope that funding can be found for an unpatentable compound
that might not provide a significant income for a pharmaceutical
company, but might provide an effective biological alternative for
many patients.
James Greenblatt, M.D.
Comprehensive Psychiatric Resources, Inc. Newton, MA
References
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