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ADHD Science Episode 10 with Brenda Leung
140 Plays11 months ago
Today we welcome Brenda Leung of the University of Lethbridge to talk about micro-nutrients in ADHD- fascinating stuff!
Her paper is here: https://link.springer.com/article/10.1007/s00787-023-02236-2
Let us know at all the ADHD UK social media what you want us to talk about next!
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Transcript
Introduction to the Hosts and Podcast
00:00:07
Speaker
Hello. Hello. Right. We are back. Happy New Year. New Year. Same us. Who are we? Who are we? This is the second take. Or third take. This is the third take. I'm Max Davie. I'm still Tess Davie. Yes. And this is the ADHD Science Podcast.
Introducing the Guest: Brenda Leung
00:00:25
Speaker
And today we're going to talk to someone who has the most amazing email signature I've ever heard in my life. So she is Brenda Leung, Associate Professor, Emmy Druge Chair in Complementary and Alternative Healthcare, Faculty of Health Sciences, University of Lethbridge, Traditional Territory of a tribe I can't pronounce who are the Blackfoot Nation. So she is from
00:00:48
Speaker
No. You don't like it when I say Canadian, but I think it's mildly amusing. I just think people might think that you believe that that's how you say it. It's Canadian.
Mainstreaming Complementary Therapies
00:00:58
Speaker
Move on. And really, really interesting talk to Brenda about complementing alternative therapies. This is basically anything outside of the mainstream that might be helpful. Indie healthcare.
00:01:15
Speaker
kind of yeah and I think that the important thing about it is that she applies evidence to
00:01:24
Speaker
these therapies and sees if they work or not. And a lot of people, me included, would say if they're evidence-based, they're no longer complementary. They come out of the kind of fringe and into the mainstream. So if she can contribute to that and our conversations can contribute to that, making these things mainstream as they become evidence-based, then all for it. All for it.
Micronutrients and ADHD
00:01:48
Speaker
Anyway, it was a very good chat. So shall we just dive in?
00:01:51
Speaker
Stay tuned, guys. Thank you, Staz. So, Brenda, welcome. Welcome. Welcome to the ADHD Science podcast. We're all going to talk about micronutrients in ADHD, a topic that I'm fascinated by and I get a lot of questions about in my clinical practice with the ADHD clinic. So, I think we get on with our first question. I have a question before that. Preliminary question. How would you define micronutrients?
00:02:20
Speaker
Ah, excellent question to start. So micronutrients are the nutrients that we find in our food. So I think many of us are familiar with macronutrients, which are your carbs, your fats, and your protein. So the micronutrients, so the nutrients that we need, but in very small amounts. So we can see carbs, fats, and protein with our naked eyes. We cannot see the micronutrients. So those tend to be the vitamins and minerals.
00:02:51
Speaker
that you hear about. Nice. Okay, well that makes sense. All right, so now we'll move on with the first question. Okay, so in your research, what question were you answering?
00:03:04
Speaker
So we wanted to know whether the use of what we call multiple nutrients, so in this case, it's the micronutrients, we call them multi-nutrients, whether that would help the symptoms of ADHD and emotional dysregulation in children. So there's been quite a bit of background research that has shown that
00:03:30
Speaker
micronutrients and multiple arrangements can help with certain symptoms in ADHD. And so before our study, there were other studies that were done, one multiple lead by a colleague in New Zealand that used a similar formula
00:03:50
Speaker
for treating children with ADHD.
Multinutrient Formula and Dosage
00:03:53
Speaker
And they had some interesting findings. And so my colleagues and I in North America thought, well, this looks really promising. Can we show some benefits using the multinutrients in this group? When you say multinutrients, we would think of like a multivitamin. What exactly is that composed of, roughly speaking?
00:04:18
Speaker
Yeah, so just as you describe, it's a multi-nutrient, so containing more than one nutrient or more than just a few nutrients. So in our case, the product that we use contained 39 ingredients. So that's all the known vitamins, the essential minerals, and it also contains some phytochemicals, which were antioxidants, as well as a few amino acids.
00:04:47
Speaker
And this particular preparation was chosen because it had been used previously by other researchers. Is that the rationale for that one? That's right. So this particular product came to attention because research has been done on it in other locations. And as I said, some of those studies showed promising results. So hence, it got our attention to do our study.
00:05:17
Speaker
just not to get too much in the weeds but is there an easy way of getting a sense of is this your 100% of your daily recommended for all of these vitamins and minerals, is it a small proportion of it, is it more than the minimum recommendation and what kind of strength I suppose, I know that's a really simplistic way of thinking of these things but what kind of ballpark of strength are we talking for these
00:05:43
Speaker
So you're asking about the amount of each of the nutrients of the product. So the number of pills that our participants were asked or take were anywhere from nine pills to 12 pills a day. So in that dosage, pretty much all the nutrients were above what's considered the RDA. So that's the...
00:06:13
Speaker
Yeah, recommended daily. Okay. Cool. I had one little question. So you mentioned that, I guess this kind of links in with the next question, which is what did you find, but were there any symptoms in particular found were affected more than others? So we were curious based on previous studies that there seemed to be an impact on what's called irritability and emotional dysregulation.
00:06:39
Speaker
which are symptoms that's been seen in children with ADHD. And so we were particularly interested in those symptoms. With our study, what we found, so we had two what we call primary outcome measures that we thought we'd use.
00:07:00
Speaker
One was clinician-rated, so we had clinician-rated what's called a global scale, the CGI, clinical global impression rating. And then the second measure was a parent reporting using an instrument called CASI, which is, let me just make sure I get this right, child and adolescent symptom inventory five.
00:07:29
Speaker
so what we call the CasC5, and that's based on the DSM diagnostic criteria. So what we found was using the blinded clinician rating, there was a substantial significant improvement in those who were taking the multinutrients compared to placebo. Whereas with the parent rating, both groups improved from the beginning to the end, but there were no group differences.
00:07:59
Speaker
So that's fascinating, isn't it? So let's just unpack that a little bit and what that means. And it's sort of slightly mind blowing kind of implications. When you say clinician, because I'm a clinician and I work with children with ADHD, are you talking about how the clinician experiences the child when they come to clinic? Yeah. So in our case, this is a global assessment. So the clinician,
00:08:27
Speaker
interacted and interviewed the child and observed their behavior throughout the duration of the study, as well as talking to the parent, again, you know, in terms of the parent's response to the questionnaires that we posed, and then interacting, talking with the child.
Study Design and Parent Observations
00:08:48
Speaker
And so that's the overall global impression rating that was used to assess the child. So I think that may be similar to what
00:08:57
Speaker
as a clinician what you would do Max? Well I have to admit I mean I know that we use Sea Gas in the UK and I've always been a little bit sceptical of it because it's sort of Sea Gas what is that? So Sea Gas is clinical global something
00:09:15
Speaker
You know, this is not a, there's not a direct critique of your paper, but the global, you know, doctors want to feel that they have got, they have made their patient better. And so mysteriously, even if actually six months later, the patient turns around and goes, well, it didn't make any difference. Whatever we did, the seagas course will always mysteriously get better during the course of treatment.
00:09:42
Speaker
because the doctor will feel that the doctors so want to feel that things are better but that doesn't account for the fact in your case that those who were on placebo and the doctors didn't know they were on placebo they were blinded they were blinded so that's the point so there is a difference between the children who were on this multi nutrient and
00:10:06
Speaker
those are on placebo, as far as the doctors are concerned, but not as far as the, so that in itself, it's like, so it would seem that there's a genuine difference between the two groups, but then what happens with the parents? So could you tell us a bit more about that? Yeah. So with the parents, um, so this is what we call a triple blinded study, right? So the clinician was blinded, the fact that the parents and the child that were taking the, uh,
00:10:36
Speaker
intervention were blinded and at the end when we were doing the data analysis, the statistician was blinded, but that's a separate story. So technically the parents did not know if they were giving their child the active multinutrients or the placebo. How well that's maintained, that's hard for us to say, although we did ask them.
00:11:01
Speaker
Um, in terms of their guests at the end of the study, what they, yeah, we did, uh, what, what they thought, what group they were in. And, um, now you caught me because we did do the analysis and I can't remember what the results were. I can find it for you. But I believe there was no, um, there was no greater guessing by chance. Yeah, sure. Right. So it was not like they.
00:11:28
Speaker
had a good inclination by group they were in. Understood. What kind of age, I'm sure you've probably already mentioned or maybe you haven't, but what kind of age were the children that you were working with? They were aged six to twelve. Okay. And the parent rating, was that like a report of symptoms at home, you know, like how they are generally
00:11:53
Speaker
Yeah, so it's an extensive questionnaire that the CASI-5 is a standardized tool that's been used. And it lists a number of symptoms for each domain following, like I said, the DSM diagnostic criteria. And so it's rated.
00:12:15
Speaker
I believe on a Likert scale of both from zero to four. So there were five options. So the Likert scale for people who kind of listening at home would be, if you were imagining a line with a number of different points along it and you just choose what are the points. It's a very familiar, everyone who's kind of done. You know, strongly disagree, strongly agree. The symptom was, you know, no symptom to severe symptoms. Yeah. Well, I was just going to ask how many children were in the study.
00:12:45
Speaker
Because I can't remember. I have read the paper, but I can't remember the number. Yeah, so we enrolled 135 children into the study from three sites. So this was a multi-site study. My colleagues from the Oregon Health Sciences University, as well as the Ohio State University, those were two American sites, and then my site at the University of Lethbridge.
00:13:13
Speaker
So we've talked a lot about how this differs between clinicians and parents, but if I was to ask you the next question, what does this mean for people working with ADHD people just like on a general scale? Can I just add something for the parents reporting where there's no group difference? So we thought about that as why that is the case. So as a parent, I think there's certain level of expectations and
00:13:41
Speaker
there are certain symptoms that the parents might pay attention to. So if there's subtle changes from a day-to-day basis over time, it's less likely to be noticed by parents, right? Because we assess them at baseline at week eight and then week 16. And so over that time when you see somebody on a day-to-day basis, you don't necessarily pick up any change over that period of time.
00:14:09
Speaker
Yes, it's not. Yeah. And in the case of parents, there were some parents who we felt were perhaps having attention challenges themselves and may not notice the changes in their own child. Imagine that.
00:14:25
Speaker
It's sort of the opposite, you know, the boiled frog analogy. It's almost the opposite. It's the benign version of that, isn't it? So, you know, if you put a frog in cold water and you slowly heat up the water, at no point will the frog won't notice the water heating up until it's actually boiling.
00:14:47
Speaker
running it because actually there's no empirical and probably would realize but the idea is it's a visual metaphor for the fact that you don't notice incremental change yeah but I I probably would have thought that it would have been the other way around that parents would notice less changes because you know there is a strong biological link with ADHD in some cases so yeah yeah if I if I had to make a guess I might have gone with the other way that parents would notice less
00:15:13
Speaker
But having said which, if you think about it... I don't know, I'm not a parent. The other way of thinking of it is whenever you, well, specifically your brother, whenever her brother has had a very rapid growth spurt in the last year, we don't really notice it, but whenever he sees a relative that he hasn't seen for a long time, what's the first thing that they say? Hello.
00:15:39
Speaker
After that. OK, yes, he's gotten so tall. He's gotten so tall. And it's not just because they can't think of anything else to say. He is qualitatively very different to when they last saw him. So in the same way, I think what Brenda's saying, they're taking over, don't you, Brenda? Frogs, Tess's younger brother. Anyway, in the same way, the clinicians are noticing a change which is so slow that the parents aren't missed.
00:16:09
Speaker
Well, speaking of height, so in this regard, that's the interesting point because we did biometric measurements. We measured height, weight, and then calculated BMI. And so, you know, we were to pick an objective measure. Those who were in the multi-nutrient group grew faster.
00:16:34
Speaker
So there was what we call a statistically significant difference between the two groups after the RCT and then after the open label as well. Yeah. And I mean, I mean, just assumed that the difference, the group difference with the clinician rating is statistically significant. Yes. That's really interesting that they grow more.
00:17:04
Speaker
And I should go back, just to go back to Tess's question that she just posed, what are the implications, if I'm a doctor and I'm looking after somebody with ADHD, what are the implications of your study and the studies that support it around multinutrients? What does it mean I should do differently? Yeah, so what we're looking to do with our study is whether multinutrients would be a feasible, viable option, treatment option for
00:17:34
Speaker
for children with ADHD. And so our finding, you know, this is one study building on other studies and the evidence seems to be growing that perhaps multinutrients, having multiple nutrients, is a possible treatment option for children with ADHD. So, you know, we recognize that not all children responded.
00:18:02
Speaker
you know, we have like 60 some odd percent as responders. So that's two thirds, which is actually a very good response to an intervention. So there are a subgroup of children with ADHD who will likely respond to nutrient interventions. So as a clinician, I mean, I think you would have to think through in terms of what that means.
00:18:32
Speaker
looking at the multinutrients as a treatment option, having that conversation with parents, I think would be valuable. And the obvious question comes, and I don't suppose for a minute you have an answer to this immediately, but
Future Research Directions
00:18:51
Speaker
What subgroup are you thinking might be the ones who would be most worth trying some multinutrients on? Yes. So you are asking the question that we are asking. That is the next step to our project. So with this particular study, we collected hair samples. We collected buccal samples.
00:19:13
Speaker
We collected stew samples, we collected urine samples, blood samples. So now we are looking at the biological samples to see if we can tease out whether there's genetics, if there's microbiome differences in those who responded versus those who didn't respond. If their nutrient overall diet pattern has the impact on whether they respond or not.
00:19:41
Speaker
So those sort of details or the mechanism aspects to the question that you're posing, Max, that we are now looking to investigate. Yeah, because the obvious question is that should you basically, is this a, is the question actually, are there subtle and undi, you know, not are there nutrient deficiencies in children with ADHD?
00:20:10
Speaker
which are not generally being diagnosed, which you are effectively treating by treating all possible nutrient deficiencies with this multi nutrient and therefore could we be more targeted? So that's I think a multi-layer question and to your question whether if there is deficiency in children with ADHD there is research that's out not
00:20:34
Speaker
What we've done, other researchers have looked at it and they have found nutritional deficiencies in children with ADHD. So iron, magnesium, vitamin D, zinc has been shown to be deficient in
00:20:52
Speaker
those children have been studied to be deficient in those nutrients. So there are some, you know, evidence showing that. And so the case for doing multiple nutrients rather than what has been done in the past, which is looking at one or very few nutrients at a time,
00:21:15
Speaker
we are biological beings. We don't use just one nutrient at a time, right? You can, you know, take your vitamin C and that will help you with not having scurvy, but you're not going to be able to live right for a long period on just vitamin C. So that's our premise that physiologically speaking for, you know, brain function, neurological function, neurotransmitter production and function. You need a complimentary of the new of
00:21:45
Speaker
you know, the full gamut of nutrients in the body. Yeah, I mean, that's true. I suppose you could say if you're being critical that if somebody is not deficient in a particular nutrient, could you be potentially potentially risking harm by giving them perhaps more than the RDA in that particular nutrient? That would be one criticism that people would probably level at this kind of strategy. Absolutely. And we've heard of that.
00:22:12
Speaker
And the response to that is with the RDA, which most people are familiar with, that was actually created. The RDA is pretty much the bare minimum amount that's recommended so that we don't suffer from a disease of deficiency. So if you take the RDA of vitamin C, you won't get scurvy.
00:22:37
Speaker
But when you're fighting an illness, if you have a chronic condition, if there's other things going on, your demand is going to be way above the RDA, right? So if you're sick and you're fighting a cold, your immune system is going to require more than the very basic level of the nutrient in order for it to be effective. So in similar vein, if we're treating a condition
00:23:04
Speaker
then we would require the levels of the nutrients at a much higher level. And the NIH recommendation in the states actually states that for research purposes, the amount that's above RDA, even above what's called an upper limit, is permissible and supported
00:23:33
Speaker
within clinical trials. It's an excellent point that the RDA isn't a target, it's a minimum and then there's quite a wider range of safe dosing. Obviously you're aware that some people in the more kind of fringe areas of healthcare give very, very large doses of vitamins for various conditions in a way that can be toxic. Absolutely, yeah, I completely agree. So it's important to be clear about that. And can I just add one more point to that then?
00:24:03
Speaker
So in a lot of those research where they've given extremely high doses of one or two vitamin that has the potential for toxicity, because again, you're narrowing into one or two. So, which is very, very, very different from a full complimentary of multiple nutrients because they do counterbalance each other. Right.
00:24:25
Speaker
Yeah, that's a really good point, actually. Have you got anything test? So I know I've been taking over a bit. No, it's OK. I was wondering, because you mentioned that there was a correlation found between ADHD and what was it? It was a bit of inefficiency. Yeah. I know it's a big question, but do you have like any sort of like inflammation or any sort of leaning that directly towards whether that's like whether that's causation or what's causing more?
00:24:55
Speaker
Yeah, that's that's a big question. Yeah. So, you know, when it comes to causation, cause and effect, when it comes to research, we're limited by the design that's that's use, right? Oh, yeah. A lot of the research would be, you know, at the population level cohorts cohort studies. And so we can say there's a correlation.
00:25:20
Speaker
What is the causation, the cause and effect mechanism? I think that still requires quite a bit more research for sure.
Challenges and Considerations in Treatment
00:25:30
Speaker
Yeah, it would be very difficult to discover in a
00:25:36
Speaker
Yeah, I'm just trying to think how you would even do it. Well, I did do it methodically. Right. Yes, you don't want to give people bitumen. No, exactly. See if they get ADHD. You could probably do that. I mean, honestly, you could probably do that sort of stuff in mice.
00:25:53
Speaker
ethically. Can you diagnose a mouse with ADHD? Oh yeah, there's lots of mouse studies with hyperactivity. You can't diagnose ADHD, but you can make mice more or less hyperactive. Rats are very good for ADHD research, but of course then you have to make this huge leap from mouse physiology to human physiology. Which is a whole problem. I'll do translate that.
00:26:21
Speaker
I had a couple of questions, sorry, before we move on from the clinician thing. One of the things that happens in the UK, and I don't know what the situation is in Canada or the US, where you obviously you'd be familiar with, is that as a doctor working for the NHS, we are only really authorized to give a certain sort of medication therapy for a particular condition. And that's made down by the NICE guidance, National Institute of Clinical Excellence. Now that's quite a difficult list to get on to.
00:26:52
Speaker
What is the situation, and multi-nutrients are clearly not on that list because the research is not at the point where it could be, but what's the situation in the US and Canada? How widely are these approved or funded by insurers?
00:27:08
Speaker
for ADHD, and can you see the situation changing? You may not know, but I'm just... Yeah, I mean, I can speak to the Canadian situation less so American colleagues would be able to address that more. So in Canada, I think it's very similar. Doctors, they have their scope of practice in terms of what they can recommend, in terms of medication. For doctors who are knowledgeable,
00:27:38
Speaker
in nutrition and nutrients. I believe they do have the ability to recommend, but the overall practice is that they don't because it's not within their scope or their training. And so that's the, I think reality in clinical, unless a doctor, you know,
00:28:02
Speaker
they do further training and do integrative medicine. And so that aspect of medical practice is growing somewhat in North America. And in terms of insurance coverage, that's one of the feedbacks that we got from our parents. We actually did a sub-study, a qualitative study with a subgroup of parents and one of the
00:28:29
Speaker
The feedbacks that we got was the expense of covering for the multi-nutrients compared to drugs. So they are what we call extended health, which is kind of like private insurance that will pay for medication, but as yet, very few, if any, would pay for multi-nutrients as part of that insurance coverage.
00:28:55
Speaker
Yeah, and that's a key difficulty. I know we want to get on to your fourth question, but I also want to, of the children who you looked after, who you were in the study, were they on medication? Were they on ADHD medication or not? So to be eligible to enroll into the study, they had to come off of their
00:29:19
Speaker
ADHD medication. So we had what we call a two week washout period for those who were on meds, wanted to be in the study. And so they were asked to stop their medication for at least two weeks before we can enroll them into the study. So once they were in the study, then they were medication free.
00:29:44
Speaker
Yeah, I would otherwise confuse our data collection analysis. Yeah, we would make it very messy. Again, just in case people are wondering. I should have been wondering. I'm disappointed in the test.
00:30:02
Speaker
Excuse me. It's not what you say to your daughter. But you two are a good tag tag team. Thank you, thank you. Hi! I don't know, I'm never disappointed in you. He's better than me. Right, full question. So, what does this mean for ADHD people themselves?
00:30:23
Speaker
Wow, that's an excellent question. Perhaps that's a question that two of you can answer instead of me. I mean, I think, again, for those who, especially children with ADHD, it's a consideration to see if multinutrient could be, whether it's a first line of treatment or as an adjunct treatment,
00:30:52
Speaker
because we know again with our study what we found with the height growth. A lot of parents whose children may go on to ADHD meds are concerned with the height suppression. So that's the opposite thing of the nutrients.
00:31:15
Speaker
Kind of have to look at, you know, Raleigh, it's not about jumping into one or the other. We know we recognize that certain medications do benefit some children, but it's a benefit risk analysis where in our case, the children grew. And for those other children who have been on meds,
00:31:36
Speaker
We, you know, the evidence seems to indicate that with a height suppression, even if they have, you know, greater caloric intake or take a drug holiday, they don't catch up in the height. Yeah. I mean, there's a small, there's a small effect of final height of medication. And it's not, I mean, for most people, it's not enough to kind of, you know, decide then not to use medication, which otherwise is going to be very important for them.
00:32:03
Speaker
But it is undoubtedly, on average, going to reduce your height by a small amount. So you're saying I could have been six foot three if I didn't do that. No, that's not what we're saying. That's not what we're saying either.
00:32:17
Speaker
So what kind of things, I'm assuming that there's something that, there's a couple like minute changes that people could make to their diets that you could use to kind of ever so slightly self-medicate. Is that, is that applicable in this, in this instance? Yeah. So the, I mean, I think we have a diet, a dietician researcher on our team.
00:32:42
Speaker
And diet would be the first place that I think we would want to look into. With the population that we are working with, initiating what's called a healthful diet is challenging because our group was age 6 to 12. So there were a lot of fuzzy pinky eaters.
00:33:12
Speaker
That's really true. Any ADHD cohort is going to have a lot of kids who've got sensory needs and sensory difficulties and also autism alongside their ADHD and will be often extraordinarily frustrating with their eating. It's very true. Oh, and I was going to say, so again, if we could, you know, get the dietary changes to work, absolutely we would support that. But in light of the
00:33:41
Speaker
challenges of getting a child to change, you know, eat the vegetables, eat the broccoli. This is sort of another way to get the nutrients in them. Yeah, some young people love broccoli, though. I love broccoli. Tess loves broccoli.
Dietary Habits and ADHD
00:33:58
Speaker
I'm really good at broccoli. He makes these like elaborate dishes all the time. And my favorite thing that he makes. There you go. So that's about what we need. A dad who cooks my broccoli.
00:34:14
Speaker
And the daughter who just magically likes broccoli. It's very good. Anyway, but I think the difficulty is because we know so little about what to be done here. This is where I'm not sort of, again, not pouring cold water on the findings here, but we don't know. So let's say somebody's got a normal zinc. We don't know that giving them zinc is not going to be helpful.
00:34:40
Speaker
within the context of a multi-vitamin. We don't know that giving them zinc on its own in a small dose is, excuse me, we think giving them loads of zinc is probably not going to be helpful because we know that zinc supplementation on its own isn't helpful, but within the context of a multi nutrient supplement, it might well be helpful, but you can't say that somebody who's got a slightly low zinc and a slightly higher zinc, there's going to be a massive difference at this point. It may be that that's true later on.
00:35:07
Speaker
At the moment, from what you've said, one of the difficulties I'm having thinking about this is that it doesn't seem to me that we can know what to do with someone's diet or whether to give them a multivitamin or not. At this point, if we take a blood test, it's not going to tell us whether it's going to help. So can I kind of spin it in a different way? So we know that
00:35:35
Speaker
In general, the general population, I believe it's true in the UK, it's true in North America, that a substantial amount of our diet do not come from what we call whole foods. So your fruits, your vegetables, right? Rather, they come from what's called processed foods, ultra-processed foods now, junk foods. So we know that the nutrient level that
00:36:05
Speaker
especially in kids that they're taking in, is not likely to be optimal. And that's being very conservative in estimating the general population's intake.
00:36:20
Speaker
So for developing brain, we need to provide those nutrients for brain development and for brain health. So while we don't know the exact characteristics of a child that may benefit from nutrients, we know that all children require nourishment and would benefit from nutrition and nutrients. And so I think
00:36:49
Speaker
Whether it's clinical or at a social level, providing nutrients to children is, I think, beneficial overall. How do you want to tease out who should get the multinutrients?
00:37:05
Speaker
I think that would be a conversation with parents, with families, and even with the child. So as we're saying, this is an option, but it's not a means of replacing or displacing other options that are there as well. So can I just give you a fun fact about the brain?
00:37:26
Speaker
You may know this. Yeah. So, you know, the brain, um, I don't know if you know, um, it's mixed about 2% of our body weight. So it's not very big. If you're a hundred percent, a hundred pounds, that's your, your brain is about two pounds, right? But it, um, it takes, it gets about 15% of our cardiac output.
00:37:55
Speaker
So 15% of the blood that's coming out of your heart goes through the brain. It uses about 20% of the oxygen circulating in your body. One little organ uses 20% of oxygen, not circulating. And it uses up to 25% of the glucose because the brain only uses exclusively glucose as its energy source.
00:38:20
Speaker
So it's a very, it's a small, you know, size-wise, it's small, but it's very, very demanding. And we know that it requires a full amount of nutrients to support that healthy brain development, growth, and function. So, you know, looking at the physiology of what's going on in the body, that in itself, I think makes sense that why we need the nourishments that we do, or the brain does, I should say.
00:38:51
Speaker
So I don't know if that confuses matters or not, but you can use that as a fun fact at your next Christmas party. Absolutely, will do. That makes everybody go with a swing. Not a lot, Chris, will I say? Yeah, it is not a lot now. I'm excited. I've already started buying presents. Yes. So there's one thing that I was wondering, I know that there are different dietary laws, like what food can be
00:39:14
Speaker
created and sold specifically I think regarding processed foods I could be completely wrong here I know nothing about this but to my understanding there is a difference in food laws in the UK and the US so do you think that because a lot of I know that a lot of your samples from Canada but a lot of it was also from
00:39:33
Speaker
the United States itself. So do you think that that would cause the sample to be more deficient in those vitamins than like other places in the world?
00:39:51
Speaker
yeah i mean i think i think yes there are differences between us particularly us which is much more lax and much more kind of less fair about food safety and britain which has still essentially got the same rules from when we were part of the when we were part of the eu no we're pretty good because because of the eu i mean obviously we're trying very hard to become as dangerous as possible over time because
00:40:19
Speaker
because we roll like that. I'm just using it as an example because obviously I know it very well. But this isn't necessarily about food safety. I think it is really interesting, this thing about the processing of foods and the nutritional content of food degrading
00:40:38
Speaker
because you know you can make a counter argument that something like let's take for example breakfast cereal there's not much more processed than Cheerios or whatever you know lucky charms whatever but they do have an off they're often fortified with a lot of vitamins and minerals certainly in the UK there's actually a very good and a lot of my patients
00:41:03
Speaker
because of their restrictive eating of pretty much their main source of vitamins is their morning cereal. So I think why I think that there is a correlation between how processed something is and how nutritionally barren it is. So, you know, chips or McDonald's or something might be quite barren.
00:41:25
Speaker
Not everything that's highly, highly processed is also barren from a nutritional perspective. So it's not, it's not quite complicated. And there is also, you know, a school of study out there, you know, trying to determine if the vitamins, minerals and nutrients you get in an apple that it's all, you know, compiled and put together by, by nature, let's say,
00:41:54
Speaker
versus a food where all the nutrients have been taken out of in the processing way and then returned to that food, right? Are they equivalent in terms of our ability to absorb and utilize?
Research Validity and Next Steps
00:42:14
Speaker
Because we know there's an intricacy in how the nutrients balance each other in a food that comes out of the ground.
00:42:22
Speaker
So we can go into talking about how an apple versus your Cheerios, even with all its nutrients put back in, how do they affect the microbiome? Because that's another big part of the conversation of the brain-gut connection. So yeah, it gets complicated.
00:42:49
Speaker
It does, and I suppose we need to draw it back to a kind of simple kind of message, which is that a fairly lowish dose, multinutrient preparation doesn't do any harm and may well do some good, but we don't know. Well, I think we know that's good for people.
00:43:12
Speaker
And so, again, back to our study, we know that in terms of the harm, there was no difference in terms of adverse effects between the multi-nutrient group and the placebo group. In fact, it was, yeah. I suppose I meant specifically for ADHD. It may do some good for your ADHD. And it probably will do some good as well.
00:43:40
Speaker
For people in general. Just for your overall, how much you glow. Oh. I don't think you should be glowing at all. That doesn't seem healthy. You know, you know. I don't think about living in monsters and aliens, if anyone's seen that, shout out. You know, when she's about to get married and her husband says, you're glowing, and she's like, oh, thank you, but she's...
00:44:02
Speaker
She's literally glowing. Yeah, and then she tells her to a giant monster. But hopefully that won't happen to us. Yes. No, let's no one turn into a giant, because we're nearly there, nearly at the end of the podcast. No one turns into a giant monster. Well, so I mean, I think in answer to your question Max, whether we know for sure, well, the evidence is building, right? That's how research works. So, you know, for those of you in the UK,
00:44:26
Speaker
By all means, please take up the mantle and do the research on this and then see what you find. I mean, this is what we found on this side of the pond, right? That'd be, I think, interesting to see what, yeah, what outcomes. Yeah.
00:44:53
Speaker
No, well, quite British.
00:45:00
Speaker
Absolutely. So you've mentioned a couple times throughout the podcast that there's a couple other things that you're looking to go into. So what would you say is our next question? Could we, you know, duplicate this in a larger sample? You know, we had 135 children in our study. So it would be, I think, useful to do the study with a larger sample.
00:45:29
Speaker
refine our questions and again, you know, what we find with our biological assays and see if they can tell us, streamline, refine our methods in the next, yeah, in a question that we would pose. Yeah, I mean, what I'm fascinated by is who within the ADHD cohort, you know,
00:45:58
Speaker
of the people of the children with ADHD who would benefit most. It feels to me my instinct would be as a clinician that the ones that I would be thinking because I can't prescribe a multivitamin or a multinutrient for them so it would be that you know they have to buy one the ones that I would be thinking about would be the ones who are on a relatively restricted diet for whatever reason you know there's an obvious
00:46:23
Speaker
benefit there. There's an obvious opportunity there to be a bit more proactive about supplementation. Yeah, absolutely. And we're hoping to answer that question more clearly next time as we do all these other analysis and assays and see what comes up.
Integrating Multinutrients in ADHD Treatment
00:46:43
Speaker
Could you, you mentioned earlier that there was, that you found that it had like a more, um, a stronger effect on irritability symptoms, right? And emotional. Uh, that was a study by, by a colleague in New Zealand. Uh, in this sample we did not know. Yeah. Okay. Okay. Cause I was, I was going to ask if you could, um,
00:47:08
Speaker
prescribe it based on that. If you had a patient who was particularly struggling with that side of things. Possibly. I generally prescribe sleep when that's the main problem. Try and get sleep as much sleep as possible. It seems the main thing. Absolutely. But that's been fascinating. It's challenging, isn't it? Because we don't think about nutrition and we
00:47:33
Speaker
And we kind of go to medication and we think about psychotherapy and stuff, but we don't really think about it. And it's also challenging because it's such a challenging evidence. The evidence is so challenging. It's not clean. It's not straightforward. There's lots of mess around it.
00:47:53
Speaker
The decision making is going to take a while to be clear about what the right course of action is. I think that motivates us to do more research and build that knowledge and collect that evidence to see where it's pointing to us. Great. Anything else from you, Tess?
00:48:13
Speaker
No, I'm all good. Everything on my notebook's crossed off. Yeah, absolutely. I'm all done as well on my little notes.
Conclusion and Listener Engagement
00:48:19
Speaker
All right. Well, thank you very much for joining us today, Brenda, and lovely to have you and goodbye. Bye bye. Bye.
00:48:29
Speaker
Okay, so that was Brenda. I hope you enjoyed her work. We're going to put a link to her paper in the bottom of the show notes. We don't tend to put people on social media on these days because no one we interview is on social media.
00:48:46
Speaker
Because they're sensible. Yes. I am not sensible. No, I am also not sensible, but we don't promote our own personal social media. Speaking of social media, you can contact us on our non-personal social medias. Yes. Social media is social media, which is... No. No one ever says social medium, do they? Which is the singular. No, social medium would be someone that's really good at talking to Instagram bots.
00:49:12
Speaker
Yeah, or a really sociable person who likes talking to dead people. That was my joke. Oh, okay. Yeah, I can contact... I can contact Michael Jackson by DMing his official account on Twitter. Okay, social media. Anyway... Long day. Long day. You've had an exam and everything. Yeah, February mocks in January. Thanks. It's not nice. Not nice. So rude.
00:49:53
Speaker
for some reason you've been out reading scientific papers and there's one that you want us to talk about go ahead if you're a researcher even better even better thank you Tess what a wonderful announcement that was so that's it for this week we've got another two episodes this season and then is it seasonal series we haven't decided
00:49:58
Speaker
you have an announcement to make.
00:50:15
Speaker
This series of the ADHD Science podcast has got two more episodes and then we're going to record the third bit. The third set of episodes is going to be recorded in February. So look forward to that. Let us know who you want to talk.
00:50:36
Speaker
about or two because there's still some slots on the third slate. Actually not all good things come in threes because there was actually four Alvin and the chipmunks movies. And on that bombshell goodbye. Good night.
00:50:55
Speaker
Editor Max here with a little announcement, maybe an appendix to Tess's excellent announcement. She didn't strictly tell you which social media to go to. It was the ADHD UK social media, Facebook page, website, whatever, to tell us what you want us to talk about. Next. Sorry about that. Got a bit overexcited about chipmunks, apparently.