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 Oligomeric Proanthocyanidins as an Alternative Treatment for ADHD by James Greenblatt, M.D.

Case Study

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

Figure 1 Theta and Beta Wave Electrophysiological Output (pW) Analysis by EEG: Following supplementation, theta wave output decreased and beta wave output increased on average for all tasks (baseline, reading, listening, and drawing) during EEG testing. Note the increased peak at 18 Hz following supplementation.

Figure 2 EEG Theta To Beta Ratio Analysis During Task Performance: The change in theta to beta ratio (uV) for each task performed (baseline, reading, listening, and drawing) with and without OPC Synergy™ supplementation.

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.

References:

• Bagchi, D. et al. 1998. Protective effects of grape seed proanthocyanidins and selected antioxidants against TPA-induced hepatic and brain lipid peroxidation and DNA fragmentation, and peritoneal macrophage activation in mice. Gen Pharmacol 30(5): 771-776.
• Greenblatt, J. M. 1999. Nutritional Supplements in ADHD. J Am Acad Child Adolesc Psychiatry 38(10): 1209-1210.
• Heimann, S. W. 1999. Pycnogenol for ADHD? J Am Acad Child Adolesc Psychiatry 38(4): 357-358.
• Mann, C. A. et al. 1992. Quantitative analysis of EEG in boys with attention-deficit-hyperactivity disorder: controlled study with clinical implications. Pediatr Neurol 8(1): 30-36.
• Schwitters, B. and J. Masquelier. 1995. OPC in practice: The hidden story of proanthocyanidins, nature’s most powerful and patented antioxidant. Rome: Alfa Omega Editrice.

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