James Greenblatt, MD

ADHD: an integrated approach


date aired: July 21, 2017

Episode Description

ADHD in increasing in our society. It is not a disease, a behavioural disorder or a discipline problem. It is a medical disorder in which genetic, neurological, nutritional & environmental factors imbalance the brain causing imbalanced behaviour. The current conventional treatments are medications and behavioural therapy. In his book “Finally Focused,” Dr Greenblatt clearly describes a sip-by-stp approach to minimise symptoms and unleashes potential.


look at nutritional, metabolic first

if meds necessary, nutrition minimize side effects


Traditionally trained mental health physician who uses

nutrition, metabolic approaches, life style recommendations, and who addresses environmental factors, anxiety, and stress

Dr. Greenblatt believes that nutrition  is an important component in treating mental illnesses


  • The second generation antipsychotic medications can result in diabetes and obesity
  • In Europe, they use less medications
  • Consider Orthomolecular approaches as adjunctive treatment
  • Treat underlying conditions; might be able to lower antipsychotic medications
    • B12 deficiency, infections, GI problems
    • Vitamin D deficiency


  • Attention deficit hyperactivity disorder
  • Most common childhood psychiatric disorder
  • Most common behavioural reason for bringing children to pediatrician
  • Its prevalence is increasing
  • Higher rates in US than in Europe
  • Untreated, can be disabling
  • Disorder is real
  • Commonly, metabolic disorders are overlooked
  • Positive attributes of people with ADHD
  • High energy, passion, multitask,
  • Can be CEOs of corporations or inventors
  • Negative Aspects of ADHD in adults
    • Increased traffic accidents, prison,  and divorce


  • Iron deficiency
  • Heavy metals including lead
  • Food allergies
  • Gut Tests


  • Are there things we want to add?
  • Are there things we want to take away?
  • Consider adding
    • Magnesium
    • OPCs
    • Life style recommendations
    • Diet
    • Supplements



  • Pesticides
  • Insecticides
  • Heavy metals such as lead and mercury
  • EMF: TV screens, IPADs
  • Sleep deprivation: sleep deprivation in infancy can predict


Clostridia  HPHPA

  • Detected with urine test
  • Interferes with production epinephrine and norepinephrine, and breakdown of dopamine
  • Can predict symptoms like schizophrenia
  • Need high dose probiotics which may reduce psychosis.
  • Increase agitation and aggressiveness
  • Probiotics help increases serotonin and GABA helping children calm down a little
  • Affects enzymes so dopamine goes up and ADHD medications may make these children worse

High copper levels

  • Give zinc for three months
  • If copper goes down treatment work better
  • Give OPC which binds copper

Multiple antibiotic trials for ear infections

  • Overgrowth of yeast
  • Antibiotics kill good bacteria as well setting up growth of yeast
  • May see candida /yeast in mouth, skin, gut
  • Organic acid test (urie see metabolites of yeast that are only in yeast
  • Can look at stool symptoms
  • Sugar makes it worse

Food Allergies

  • Neglected part of our treatment
  • Vast majority of children under age 6 have food allergies
    • , wheat, gluten

Sign of food allergies

  • Face gets red, ears get red
  • One ear getting red
  • Black circles under they eye
  • Cravings for food that child is allergies to
  • Behavior, irritability temper, shorter attention span, loud talk
  • Might not be quick
  • Is delayed food hypersensitivity
  • Might take one to three days
  • Usually physical symptoms over hours
  • Can look at food test
    • IgG food allergy tests
    • Not 100 % accurate
    • Is a guide
    • Eliminate offending food, behavioural might get better
  • Physiological Responses to Food Sensitivities
    • Blood sugar reaction; blood sugar increases
    • Pulse goes up 5 – 10 points, up to 20 – 30

Elimination Diets to address food sensitivities

  • Recommended for years
  • Introduce food one at a time
  • Symptoms might occur quickly


  • Varies depending on individual sensitivity
  • Adults who present for the first time with inattention, many celiac patient found
  • Deficient in iron and zinc from celiac disease destroying the gut
  • Check in chronically ill patients recommend trial off gluten



  • Magnesium, zinc, iron
  • Magnesium is the most common deficiency in ADHD patients
  • Magnesium can minimize the side effects of ADHD medications (irritability and anxiety)


  • Lots of research
  • Low levels of zinc in ADHD
  • Zinc helps treat
  • Many country use zinc with ADHD meds
  • Zinc helps increase effectiveness of ADHD medications
  • Stabilizes neurons and neurons coating
  • Need zinc to convert serotonin to melatonin
  • Deficiency in depression, nervosa nervosa, and sleep disorders


  • See-saw (inverse relationship) with copper

Dark chocolate

  • Regulate norepinephrine, epinephrine
  • Decreases glutamate

Phytochemicals OPC (oligomeric proanthocyanidans)

  • Blueberries, green tea, red wine, dark chocolate
  • Help attention
  • Cognitive function
  • Slow release histamine
  • Protect against lipid peroxidation
  • Strengthen blood brain barrier
  • Increase enzymes that decrease inflammation

Pinebark extract (pycnogenol)

  • OPC that has a lot of research behind it
  • Normalize neurotransmitters
  • Attention, ADHD
  • Cognitive symptoms
  • Alertness, focus decrease impulsivity restlessness, aggressiveness
  • Decreases oxidation

Green Tea

  • Lots of research
  • Has OPCs
  • For adults in cognitive decline

Lithium Low Dose (Nutritional lithium

  • Nutrient in our soil, water
  • Areas with lo depression, suicide, violence and aggression
  • Prevent Alzheimer’s and cognitive decline
  • Decreases aggression
  • Protect brain cell
  • No blood levels
  • Screen for thyroid and kidney


  • Microbiome 4-5  pounds of bacteria  almost weight of brain
  • Affects mood, behavior
  • Can result in severe neuro psychiatric symptoms
  • Look at chemicals affect the brain
  • Looks at probiotic and prebiotics
  • Gut’s affect on mental condition
    • There is a subset of ADHD kids and other mental disorders or which this
    • Contributes to subset of autism


  • higher protein better for attention and ADHD
  • High protein breakfast with low glycemic load
  • ADHD patients tend to be more sensitive to blood sugar swings.
  • some research shows that people with ADHD don’t metabolize carbs right
  • refined carbs blood sugar drops problem
  • Various diets are healthy
  • Is what are not eating
  • Eliminate junk food, sugar, artificial sweeteners


  • Important in ADHD and in all health
  • Sleep deprivation leads to inflammation
  • High rates of sleep apnea
    • sometimes related to weight
    • treatment is CPAP or dental appliances
  • Assess if snoring
  • Tend to sleep less
  • Look at
    • magnesium
    • melatonin
    • Glycine
    • Theanine
    • Tryptophan for adolescents and adults 500 mg  or 1 – 3 grams


  • Helps with depression
  • Increases BDNF (brain derived neurotrophic factor) enhances mood, peptides, hormones
  • Persons with ADHD do better after exercise
  • Martial arts successful with ADHD children
  • Walking
  • Yoga


  • Green spaces approved attention (“Vitamin N”)


  • Research shows improvement
  • Walking meditation during any activity


  • Listen to child
    • How do you study best?
  • Walking with child
  • Teach mindfulness what are seeing, hearing, body and what is around them
  • Don’t be critical and harsh
  • Don’t punish
  • Ask, respect the illness
  • Find environments whether children do better
    • One on one, structured
  • Imagine chi as sand. If you squeeze too tightly, it goes through fingers


  • Look at nutrition and life style first
  • Then consider medications