Food Additives and ADHD: New Evidence of Genetic Factors involving Histamine

Just in time for Halloween, a post about candy, children, and behavior problems.  For many years, parents have noted an association between certain foods and their children's behavior.  "If he eats candy he's out of control."  "If she has anything with red dye in it, she'll be up all night."

These observations have caused many parents to have intimate knowledge of ingredient lists of food items, searching for things like sunset yellow, tartrazine, sodium benzoate, carmoisine, ponceau 4R, allura red, and quinoline yellow.  Avoiding these can be challenging -- find a processed food without sodium benzoate.

Double-blind, placebo-controlled trials have shown that artificial food colors have a significant effect in children with ADHD.  However, many have not been convinced of the association, given a lack of plausible explanations for how this range of food additives could cause behavior changes, including inattention, impulsivity, and overactivity.  Granted, any child will have these characteristics at times, but the Attention Deficit Hyperactivity Disorder (ADHD) diagnosis is reserved for those with such severe symptoms that they interfere with home and school functioning.  And, even in toddlers and 4th-graders without ADHD, food additives have been shown to have and adverse behavioral effect (McCann et al, 2007).

Most of the treatments for ADHD have direct effects on the brain chemical, dopamine.  Indeed, genes influencing the dopamine system (eg, DRD4, DAT1) have been found to be involved.  Yet, there has not been clear evidence of a connection between food additives and dopamine.  There have been some observations that certain food dyes can provoke the release of histamine, causing hives and itching but also inattention, hyperactivity, and dopamine release in prefrontal brain areas.

In the October issue of "the green journal" (American Journal of Psychiatry), McCann's group analyzed six genetic polymorphisms (I explained these here) involving genes affecting dopamine and histamine (Stevenson et al, 2010) in the same group of general population kids (not just those with ADHD) from the 2007 study.  What they found provides one possible explanation for why these additives cause behavior problems.

They found that two polymorphisms in the histamine enzyme gene, HNMT, and one in the dopamine transporter (DAT1) gene, were associated with inattentive and hyperactive symptoms when kids were given juice with the additives in it, compared with juice without the additives.

Meaning that children with these specific polymorphisms (think a genetic code swap, like the difference between "their" and "thier") will have an enhanced effect of histamine on their brain's histamine (H3) receptors and an altered effect of dopamine on the brain.

So, what's it mean?  It means those parents were right, of course.  And, for foods that are targeted for children, the food industry now should pay attention (!) to finding alternatives to these artificial chemical additives.

Tell Me About Your Mother

It's the typical shrinky line, so I'm using it to introduce a new website on Mother-Daughter relationships (and all their angsty stuff). Check it out at Motherrr.com ! Ah, the site is run by my sweet Cousin B and her friend, and no, they aren't shrinks.

I'll leave it to Clink to tell you about the Shrink Rapper holiday dinner last night at Mr. Rain's Fun House. Oh, why not: I threw red sea salt at Clink and Roy ate a gourmet dog biscuit that Clink had brought from the Ben & Jerry's store in Vermont. The food was good, too. Purple soup and cotton candy baked alaska, anyone?

A Session With Dr. Whippy

Artist Demitrios Kargotis has invented a soft-serve dispensing machine which uses voice-stress analysis to determine how much soft serve to give to the customer...er...client...er...patient. The more stressed out you are, the more soft serve you get.

But will insurance reimburse?

Just As I Was Thinking About You

I think I have ESP. Last week, I was thinking about a patient I hadn't seen in a couple of months, and he called, just as I was thinking about him. It's happened before with this patient. Today, I was walking to my car (where I'd left my cell phone, unsubmergered), and I started to think about a patient I haven't seen or thought about in some time. I've been treating her for over ten years, and issues of age and health have made it hard for her to get in to see me. It's been a year, maybe more, but every once in a while, she surfaces. So I'm thinking about her, wondering how she is, and I get to my car and there's a voicemail from her. Sort of eerie. I have ESP.

What I don't understand is the whole ShrinkRap with Bacon thing on our sidebar. I guess Roy did this. Why does anyone want bacon with our blog? It's just sort of weird. He couldn't have put ducks up?

And for a final thought: my husband is leaving on a jet plane. He texted to say there is a comfort dog in the next row. I can't wait to hear how the flight goes.

Thanks to everyone who's commented on our pre-draft of a chapter. I like the diversity of opinions. And to anyone who thinks their middle schooler might get something out of it, that would be wonderful!

I'll get a photo in later: let me know if you have any special requests....

Programmed Prescriptions

Today a computer told me that I couldn't use Prozac. More specifically, it said that the use of Prozac was contraindicated in people diagnosed with bipolar disorder. This experience led me to conclude that the only thing worse than having an insurance company tell you how to treat your patient is having a computer tell you how to treat him.

I'm required to use an electronic medical record. I don't generally mind this. The constant typing and the amount of time required for data entry is a pain in the rear, but I know it's the best way to ensure continuity of care between prisons. The problem is that the system also has preprogrammed treatment algorithms. I have no idea where they came from, who decided them and what data they're based on, but they exist. Episodically the computer tries to tell me how to practice.

The computer algorithm has also told me not to use lithium with people who are also on certain blood pressure medications and serotonergic reuptake inhibitors with people who have hepatitis. The computer doesn't say "be careful about this combination because it can cause X, Y or Z problems" or "be sure to watch drug levels more closely with this combination". It says, "Use of this drug is contraindicated in these conditions". Then, in order to continue entering the prescription, you have to click an "acknowledge" button to document that You Have Been Warned.

Truly, this is annoying on so many levels.

It's a CYA maneuver so the nameless Company can say it warned you if anything goes wrong. It's unnecessarily alarmist. It confuses the medication nurses who occasionally check to make sure the meds are OK to dispense. But more importantly, it's just bad information. These medication combinations are still effective, and they can be used safely, you just have to monitor them more closely. The geek who designed the system doesn't know this, he or she just programmed in the information he was told to put in. It probably seemed like a good idea.

And it will be someday, once computers are granted prescribing privileges.

*****************

And now I want an opinion from our readers. It's got nothing to do with psychiatry.

If you make hot cocoa from cocoa powder and other ingredients, instead of using hot water and a bag of cocoa mix, is that considered 'homemade'? Dinah says it's all one and the same. I say it's making cocoa 'from scratch' just like baking a cake without using a boxed mix.

What is your definition of 'from scratch'? And what's your favorite hot chocolate recipe? I'm looking for suggestions.