BEATING ATTENTION DEFICIT DISORDER
(or Nutrition and
Nootropics For Focus & Attention)
By James South MA
“Concentration” denotes the ability to sustain focused attention on a given
object, external (such as people or rocks or colors), or internal (such as
thoughts, feelings or sensations). The power of concentration also
involves the ability to screen out irrelevant distractions that might divert or
disrupt sustained, focused attention. Although animals can concentrate to
some extent (e.g. a lion focusing on the animal chosen for its dinner),
concentration as a volitional power reaches its zenith only in humans. Only
humans can concentrate on things that do not yet exist (such as a building that
exists only in the mind of its architect), or on such abstract notions as
“infinity,” “justice”, or “eternity.”
Yet concentration for humans is a very practical, mundane necessity of life.
Psychiatrist Daniel Amen reports that adults who come to his clinic suffering
from ADD (attention deficit disorder), a serious disorder of concentration,
typically are concerned with poor school or work performance caused by such
concentration-related symptoms as difficulty sustaining attention to reading or
paperwork; tendency to being easily bored by tedious material; poor planning and
organization; chronic procrastination; restlessness and non-phobic difficulty
staying in confined spaces; difficulty listening carefully to directions;
frequent lateness for work or appointments; and tendency to misplace things.
They also frequently complain of difficulty thinking clearly; poor
self-discipline, mood problems, anxiety, restlessness, drug abuse, temper
problems, marital problems, insomnia, over impulsiveness, and money
problems. And all of these problems in turn relate to their difficulty
with sustaining attention and resisting distractions. (1)
ADD AND ADHD
Amen notes that ADD has been present in some form in all four of the editions
of the Diagnostic and Statistical Manual of the American Psychiatric
Association, although the condition’s name has changed in each edition. ADD is
therefore not just some recent “fad” diagnosis. It is currently labelled
“Attention Deficit /Hyperactivity Disorder” (ADHD), although many children and
adults lack the hyperactivity component of the attention deficit syndrome.
(2)
There is a core group of symptoms common to those who have ADD. These include
difficulty focusing attention; difficulty organizing tasks, space and time;
difficulty following tasks through to completion; easy distractibility; poor
self-supervision; forgetfulness; and poor attention to detail and careless
mistakes. (3,4)
Psychiatrist Amen diagnoses AD(H)D based in part on careful symptom
questionnaires, as well as medical and family history. However, his clinic
specializes in using a neuro-imaging technology called SPECT to more
definitively establish the diagnosis. “SPECT” is Single Photon Emission
Computed Tomography. It involves injecting a mildly radioactive substance into
the patient’s bloodstream which is easily taken up by brain cells. Then,
either at rest or during a concentration session, a special gamma ray camera
photographs the brain from multiple angles over a 15 minute period. A
supercomputer then reconstructs 3-dimensional images of brain blood flow levels.
(5) Clarke and Sokoloff report that neuro-imaging studies “… establish that
local energy metabolism in the brain is coupled to social functional activity
and confirm the local cerebral blood flow is adjusted to metabolic demand in
local tissue.” (6) Through the SPECT maps, physicians have been able to
identify certain patterns of brain activity that correlate with psychological
and neurological illnesses. (7) Amen is probably the current leading expert on
SPECT imaging, having conducted about 10,000 patient SPECT studies. (8)
ADD: THE 6 TYPES
Through his extensive clinical research conducted over the past dozen years,
involving 10,000 SPECT studies and 15,000 patient evaluations, Amen has been
able to subdivide ADD into 6 subtypes. (8A) Type 1, or “classic” ADD,
involves a normal resting brain, but during concentration there are decreases in
metabolic activity in the underside (orbito-frontal) and topside (dorsolateral)
prefronal cortex. (9) It should be noted that the “lion’s share” of brain
metabolic activity – about 40%-goes to operating the membrane sodium-potassium
pumps that make the brain electrical activity possible. (10) Thus, reduced brain
metabolic activity necessarily equals reduced brain electrical activity.
And since brain electrical activity drives neurotransmitter release (11),
reduced brain metabolic activity also equals reduced brain neurotransmitter
activity. Amen has defined the primary symptoms of “classic” ADD (really
ADHD) as inattentiveness, distractibility, disorganization, hyperactivity,
restlessness and impulsiveness. (12)
Type 2, or inattentive ADD, involves a normal resting brain, with reduced
metabolic activity in the dorsolateral prefrontal cortex during concentration.
Primary symptoms include inattentiveness, sluggishness, slow-moving,
low-motivation, frequent boredom, with sufferers frequently described as
spacecadets, daydreamers, or couch potatoes. (13)
Amen’s Type 3 is called “overfocused ADD.” SPECT findings show increased
metabolic activity at rest and during concentration in the anterior cingulate
gyrus, (a brain region connecting the prefrontal cortex and limbic
system). During concentration there is also reduced metabolic activity in
the orbitofrontal and dorsolateral prefrontal cortex. Over-focused ADD
people have trouble shifting attention and frequently get stuck in negative
thought or behavior patterns. They are also obsessive and worry
excessively. They tend to be inflexible and are frequently argumentative
and oppositional. (14)
Type 4 is temporal lobe ADD. At rest and during concentration there is
decreased (occasionally increased) temporal lobe activity. During
concentration there is typically reduced activity in the orbitofrontal and
dorsolateral prefrontal cortex. Temporal lobe ADD symptoms include
inattentiveness, impulsiveness, learning difficulties, unstable moods,
irritability, dark thoughts, and aggressiveness. (15)
Type 5 is limbic ADD. SPECT findings include increased deep limbic activity
(thalamus and hypothalamus) both at rest and during concentration, and decreased
activity in orbitofrontal and dorsolateral prefrontal cortex. Symptoms include
inattentiveness, low-grade depression, low energy, feelings of hopelessness,
chronic negativity, and perceiving situations in the worst possible light.
(16)
Amen’s Type 6 is called “ring of fire” ADD. SPECT findings include, both at
rest and during concentration, patchy increased activity across the cerebral
cortex, with focal areas of increased activity, especially in the parietal
lobes, temporal lobes, and prefrontal cortex. Symptoms are inattentiveness with
extreme distractibility, anger/irritability, moodiness, verbosity, and extremely
oppositional. (17)
Amen’s book contains a 71 question questionnaire to help the reader decide if
he might possibly suffer from one of the 6 ADD types. He also provides many case
histories of each ADD type, with before and after treatment SPECT photographs,
that are very helpful in seeing the psychological/behavioral and neurological
differences among the types.
Amen’s treatment regimen is extremely broad, involving biological,
psychological and social interventions. (18) His biological treatments focus on
eliminating toxins, including caffeine and nicotine because they decrease brain
blood flow; avoiding activities with high risk of head injury; dietary changes –
a high protein, low sugar diet for all except over-focused ADD; intense aerobic
exercise; avoiding prolonged exposure to video and computer games; medication –
including Ritalin® or amphetamines; and nutritional supplements, including a
complete multivitamin/mineral supplement, as well as St. John’s Wort, 5-HTP,
DL-phenylanine, tyrosine, GABA, and fish oils, with the specific supplements
varying depending on the type. The interested reader is referred to Dr. Amen’s
book for more detail. (1)
TO RITALIN® OR NOT TO RITALIN?
Perhaps the most controversial, (at least to orthomolecular nutritionists,
naturopaths, and “holistic’ physicians) part of Dr. Amen’s treatment regimen is
his frequent use of Ritalin (methyl-phenidate-MPH) and amphetamines (AMP).
Actually, among “mainstream” practitioners of ADD medicine, MPH and AMP are not
controversial – they are routinely used to treat presumed AD(H)D cases. Yet a
growing movement, led by Dr. Peter Breggin, challenges the need, safety and
efficacy of MPH/AMP use in children or adults. (19) Breggin points out
that the effects of MPH and AMP are almost identical, and that neither are
safe. (20) Breggin quotes a 1995 DEA report that “The potential
adverse effects of methylphenidate and d-amphetamine are almost identical.” (21)
These potential side effects include heart palpitations, increased heart rate,
increased blood pressure, excessive CNS stimulation (including convulsions),
toxic or organic psychosis, depression, dizziness, headache, insomnia,
nervousness, irritability, tic syndromes, appetite loss, nausea, vomiting,
stomach pain, weight loss, growth suppression, blurred vision, low white blood
cell count, anemia and hypersensitivity reactions. (22) Breggin also provides
evidence that MPH/AMP may cause gross brain malfunction/brain damage, especially
in children, whose brains and synaptic connections are still developing.
(23) Breggin also cites extensive evidence that MPH/AMP may promote what
he calls “the zombie effect,” snuffing out enthusiasm, curiosity, initiative,
spontaneity, and exploration, while making children obsessed with meaningless,
robotic activities, and turning them into compliant, docile “robots.” (24)
Anyone who is on, or who has a child on MPH/AMP, or who is considering MPH/AMP
for their child or themselves, should definitely read Breggin’s book before
making a final decision on MPH/AMP use, especially since there are many
non-toxic nutritional/nootropic treatments that may work well in improving
concentration and focus.
THE NEUROBIOLOGY OF ATTENTION 101
In order to understand the rationale for the nutritional/nootropic treatments
offered later in this article, it may be helpful to gain at least a brief
overview of the neurobiology of attention. Over the past 50 years, neuroscience
has identified four distinct components that make up the brain’s attention
system: arousal, motor orientation, novelty detection and reward, and executive
command. “At the lowest level, the brainstem maintains our vigilance – our
general degree of arousal. At the next level, the brain’s motor centers allow us
to physically reorient our bodies so that we can redirect our senses [as
needed]. Then, the limbic system accomplishes both novelty detection and reward.
Finally, the cortex-especially the frontal lobes – commands action and reaction
and integrates our attention with short – and long-term goals.” (25)
Arousal is mediated through circuits which connect the brain stem reticular
activating system (especially the noradrenaline-using locus coeruleus [LC] and
the dopamine-using ventral tegmental area [VTA] with the prefrontal cortex,
posterior cortex, limbic system (including thalamus and nucleus accumbens) and
sense organs. (26,27) The LC and VTA are essential in activating the
frontal lobes – the most distinctively human brain structures.
Under-activity of the LC or VTA may in turn lead to underactive frontal lobes
(28,29) – a routine finding in Amen’s SPECT studies.
The brain’s motor centers help us focus/refocus attention in three steps.
First, the posterior parietal cortex helps us disengage from a stimulus.
Then, the basal garglia and frontal parietal attention circuits shift the focus
of attention to something new. Finally, neurons in the thalamus engage
attention by focusing the brain on the new stimulus while inhibiting other
distracting signals. (30) Once we are aroused and oriented, the brain’s
novelty/reward system is activated, governed by VTA dopamine neurons. The
VTA-limbic system (hippocampus) circuit takes note of novelty, while the nucleus
accumbens in the limbic system is a key part of the reward system. The
nucleus accumbens is well-connected to the VTA dopamine system, as well as other
parts of the limbic system. (27,31)
Damage to or under-activity of the reward system leads to difficulty
sustaining attention to matters that don’t provide instant gratification. (32)
People with “reward deficiency syndrome” are often impulsive, lack inhibitions,
and are quick to act because they are “hooked” on immediate positive feedback.
Monkeys with lesions in the nucleus accumbens are unable to sustain attention.
(33)
The fourth system of attention-executive command – directs our actions and
integrates attention with our goals, and is centred in the frontal lobes,
especially the prefrontal cortex. The frontal lobes also interact with the
posterior (sensory) cortex, inhibiting the posterior cortex from raising
irrelevant, distracting stimuli to focal awareness. (28) “The frontal lobes …
are linked to intentionally, purposefulness and complex decision making ….
They co-ordinate and lead other neural structure in concerted action. The
frontal lobes are the brain’s command post …. even subtle damage to the
frontal lobes produces apathy, inertia, and indifference ….
ADD and ADHD are caused by subtle dysfunctions of the frontal lobes and the
pathways connecting them to other parts of the brain …. True to its
‘executive’ functions, the prefrontal cortex is probably the best connected part
of the brain. The prefrontal cortex is directly interconnected with every
distinct functional unit of the brain…. Of all the structures in the brain,
only the prefrontal cortex is embedded in such a richly networked pattern of
neural pathways.” (34) From this brief description of the neurobiology of
attention, several things should be obvious.
1) Concentration (focused attention) is a whole-brain activity.
Virtually every part of the brain is involved in mediating attention.
2) While almost every brain structure is essential to making
concentration possible, the prefrontal cortex is “first among equals.”
Under-activity (or over-activity, in “ring of fire” ADD) of the prefrontal
cortex is the common denominator of all 6 ADD types described by Amen.
THE BRAIN IS EASILY WOUNDED
Neurologist/neuropsychiatrist Elkhonen Goldberg emphasizes repeatedly in his
book The Executive Brain that the frontal lobes are easily wounded. Thus he
notes “The frontal lobes are exceptionally fragile …. When neurological
illness affects the frontal lobes, the ability to stay on track becomes lost,
and the patient is completely at the mercy of incidental environmental stimuli
and tangential internal associations…. attention deficit hyperactivity
disorder (ADHD), with its extreme distractibility, is usually linked to frontal
lobe dysfunction…. deficit of attention is among the most common consequences
of brain damage …. In most such [ADHD] cases biochemical disorder affecting
the frontal lobe connections is present, but there is no structural damage to
the frontal lobes …. Damage to the frontal lobes produces wide ripple effects
through the whole brain. At the same time, damage anywhere in the brain
sets off ripple effects interfering with frontal lobe function.” (36)
OPTIMIZING BRAIN FUNCTION TO ENHANCE CONCENTRATION
Concentration is not an all-or-nothing state. There are gradations in
concentration, from none (in coma) to the extremely high level of a chess
grandmaster focusing on 20 moves ahead of his current move on the chessboard.
ADD represents a significant impairment of attention, but even in ADD it’s not
all-or-nothing. Both Amen and Goldberg note that attention deficit in ADD
is often selective. (37, 38) Things that are novel, stimulating, interesting or
frightening provide enough stimulation (through adrenaline release) to help ADD
people pay attention in these contexts. It is the routine, mundane, boring,
trivial, rote activities that fail to stimulate ADD brains to concentrate.
Similarly, attention is not at a fixed level in “normal” people, either.
The more healthy overall brain function is (especially frontal lobe function),
the more effective and effortless concentration becomes. Thus, both ADD
sufferers and “normal” people can improve their concentration abilities through
optimizing their brain function. Various nutritional strategies and
nootropic drugs can synergistically improve neural function, often
dramatically.
GLUCOSE REGULATION
Glucose is the principal brain fuel. Most other cells and organs of the body
are able to “burn” fat as well as glucose to produce ATP bioenergy, but brain
neurons can only burn glucose under normal, non-starvation conditions. (39) The
brain is only 2% of the body mass, yet typically consumes 15-20% of total body
ATP energy. (40) The brain is dependent on a second-by-second delivery of
glucose from the bloodstream, as neurons can only store about a 2-minute supply
of glucose (as glycogen) at any given time. (39) The brain must routinely have
access to a large portion of the glucose flowing through the bloodstream.
Yet the modern high sugar, high refined carbohydrate (CHO) lifestyle creates
serious potential problems for the brain. Unlike most other body tissues, the
brain does not require insulin to absorb glucose from the blood. (39) Thus, the
optimal blood status for the brain to acquire its disproportionately large share
of blood sugar is a normal blood sugar level (70-100 mg %) combined with low
blood insulin. When insulin is low or absent in the bloodstream, the rest of the
body will ignore the blood sugar and burn fat or amino acids for their fuel.
The chief stimulant for insulin release is CHO. (41) A surge in blood sugar
(glucose) from rapidly absorbed dietary sugar/refined starch may increase
insulin levels 10-fold within minutes, and keep on increasing insulin to even
higher levels for 2-3 hours. (41) This will cause a rapid glucose uptake by
almost all body tissues, leaving far less than optimal supplies for the brain.
(42)
The modern Western diet typically contains 50% or more of its calories as
CHOs, mostly as simple sugars and refined (de-fibered) starches. Many ADD
sufferers (and “normal” people, as well) start their day with a super-CHO
breakfast. Cereal with sugar or fruit, toast or muffin and jam, waffles or
pancakes with sugar syrup, doughnuts, pastries, “pop-tarts,” etc. are “normal”
breakfast foods in much of Europe and America. Many people consume mid-morning
snacks of doughnuts, pastries or croissants with sugar-laced coffee. Many people
routinely eat lunches rich in bread, pasta, potatoes, rice, corn/potato chips,
etc. topped with sugary desserts. Dinners are also often CHO-rich: pizza. pasta,
potatoes, bread, chips, sugary dessert, etc. And these high-CHO meals are often
washed down with sugar-rich soft drinks. The typical Western diet is a virtual
recipe to promote hyperinsulinism, with consequent reactive hypoglycaemia (low
blood sugar following CHO-rich meals).
HYPOGLYCAEMIA & ATTENTION
Dr. Stephen Gyland was an American physician in the 1950s who studied 1307
cases of hypoglycaemia from his clinical practice. (43) Among his hypoglycaemia
patients, 89% suffered from irritability, 67% forgetfulness, 57% mental
confusion, 50% indecisiveness, 43% in-coordination, and 42% lack of
concentration. (44) These are all signs of hypoglycaemia’s negative effects on
the brain. Goldberg notes that indecisiveness is a classic indicator of poor
frontal lobe function. (45)
Bonnie Spring and colleagues reported an experiment that compared high
protein and high CHO meals. They observed that among older (40 or above)
subjects eating a high CHO lunch, attention was significantly impaired in
performance tests. (46) Gibson and Blass state that ”… a high carbohydrate
diet (78%) low in fat (12%) and low in protein (10%) markedly decreases brain
glucose utilization…. even marginal protein dietary deficiency when coupled
with a carbohydrate-rich diet suppresses cerebral glucose utilization to a
degree often seen in metabolic encephalopathies [brain diseases].” (47)
Amen reports that he has found a high simple CHO diet makes concentration
problems worse for most people, especially those prone to ADD. He has found that
most ADD children and adults function better on a high protein, low simple CHO
(sugar) diet. (48)
Thus, the simplest method of enhancing focus and attention is to adopt a high
protein, low simple CHO diet. Reduce or eliminate sugar-and-flour-rich foods,
and derive CHOs mainly from nuts, seeds, beans, and peas (moderate quantities)
and low-CHO vegetables, Avoid sugar-laden soft drinks and sugar-laced
coffee.
BRAIN ENERGY
As noted earlier, the brain must use 15-20% of the body’s total ATP energy
supply. Neurons cannot borrow this ATP from other cells – it must all be
produced within the brain from the metabolism of glucose. The conversion of
glucose to ATP energy occurs in 3 stages inside each neuron. The 3 interlocking
phases of glucose metabolism are glycolysis, the Kreb’s or citric acid cycle,
and the electron transport chain (ETC). The Kreb’s cycle and ETC both occur
inside the mitochondria, the tiny “power plants” of the cell, and produce most
of the cell’s ATP. Various enzymes gradually convert glucose to ATP. These
enzymes require an activating partner, a “coenzyme” to function properly. The
coenzymes are all active forms of various B vitamins. The vitamins used in the 3
interlocking ATP cycles are vitamins B1 (thiamin), B2 (riboflavin), B3
(niacinamide), B5 (pantothenate), biotin, and the B-vitamin-like substance
alpha-lipoic acid, as well as coenzyme Q10. Other B vitamins, such as B6
(pyridoxine), B12 (cobalamin) and folic acid are used to transform various amino
acids into forms that allow small quantities of them to be “burned” in the
Kreb’s cycle. (49) These vitamins must be converted to their active, or
coenzyme, forms to become functional. E.g., B1 becomes thiamin pyrophosphate, B3
becomes nictinamide adenine dinucleotide, etc.
It was Linus Pauling, in 1968, who first observed that dietary and blood
levels of various B vitamins that are adequate to feed all the other cells of
the body, may not be adequate to nourish the brain. This is due to the
blood-brain barrier (BBB). (50) The BBB serves to protect the vulnerable brain
from many toxins, but it is primarily water-soluble substances that the BBB
excludes. (40) All the B vitamins are water-soluble, and are only poorly
transported across the BBB. Thus, Pauling noted that many people (especially
those with any form of brain malfunction), may require much higher than RDA
(recommended dietary allowance) levels of vitamins to achieve high enough blood
levels to “push” adequate amounts of B vitamins through the BBB. (50)
As one clinical example of this phenomenon, Lonsdale and Shamberger reported
in 1980 that 20 patients consuming a “junk food” diet showed biochemical
evidence of a serious thiamin deficiency, and presented with symptoms similar to
ADHD. When supplemented with 150-300 mg thiamin/day, their behavioral problems
improved – yet the 1980 RDA for thiamin was only 1.7mg. (51) In his classic book
Nutrition and Vitamin Therapy, psychiatrist M. Lesser reported inability to
concentrate, poor memory, apathy and slowing of intellectual processes as
consequences of deficiency in vitamins B1, B3, B6, B12 and folic acid. (52)
Lesser also routinely recommends B vitamin supplementation at higher-than-RDA
levels for optimal mental health and functioning. (52)
A simple nutritional method to improve mental energy and concentration is the
routine supplementation of B vitamins, alpha-lipoic acid, and CoQ10 (or its
improved analogue, idebenone). Lipoic acid and idebenone also provide important
antioxidant benefits to the brain, as well. Lipoic acid, and its
inter-convertible reduced form, dihydrolipoic acid (DHLA), scavenge a broad
range of free radicals and oxidants, including hydroxyl/radicals, peroxynitrite,
hydrogen peroxide, singlet oxygen, superoxide radical, and peroxyl radical. (65)
DHLA also recycles the major cell antioxidants vitamin E, vitamin C,
glutathione and CoQ10. (65) Idebenone reduces oxygen radical formation, and is a
far more effective antioxidant than CoQ10. (66,67) These benefits are especially
important to the brain, as it has relatively poor antioxidant defences, and
increasing brain mitochondrial energy production will also increase free radical
formation. (65)
Typical daily doses would be 10-100mg B1 and B2, 50-250 mg B3; 50-200 mg B5;
25-100 mg B6; 1-5 mg B12; 0.5-10 mg biotin; 0.8-5 mg folic acid; 50-200 mg
alpha-lipoic acid; 50-100 mg CoQ10 or 45-90 mg idebenone. For those wishing a
“hi-tech” approach, a sublingual coenzyme B formula with CoQ10 is available. I
formulated this product for Source Naturals in the early 1990s. It contains
coenzyme B1, B2, B3, B6 and B12. It also contains pantetheine, a form of B5 that
is more easily converted to coenzyme form than B5, as well as folic acid,
biotin, and CoQ10. The sublingual form is best, because the coenzyme will be
absorbed directly into blood vessels in the mouth. When coenzyme Bs are
swallowed, they are broken down by intestinal lining enzymes during digestive
absorption. Methylcobalamin is the “neuro-active” form of B12. It is
also now available in 1 and 5 mg sublingual tablets.
For more detailed information on energy metabolism, B vitamins, the RDA vs.
optimal vitamin levels, etc., the reader is referred to my article “Tired of
Being Tired?” in the Winter 1999 IAS Anti-Aging Bulletin.
MAGNESIUM: MINERAL FOR THE MIND
Magnesium (Mg) is the activator mineral for over 300 different enzymes – more
than any other mineral. (53) Mg serves as the mineral activator for most
of the enzymes of the glycolytic and Krebs’ cycles. (54) Once ATP is produced,
it is normally complexed with Mg for stable storage. (55) Mg activates
sodium potassium ATPase, the membrane pump which transfers sodium and potassium
across neural membranes to allow repeated bursts of electrical nerve activity
(56), and which consumes up to 40% of neural ATP. (10) Mg regulates the
activity of NMDA glutamate receptors, and thus glutamate nerve activity. (57)
Glutamate nerves are the chief excitatory nerves, and are the primary neurons,
along with the GABA nerves, in the brain areas connected with attention: the
frontal cortex, hippocampus, striatum, thalamus, hypothalamus, and posterior
cortex. (58)
Given Mg’s myriad roles in human physiology, it is perhaps not surprising
that cellular Mg deficiency leads to a wide variety of symptoms: anxiety, fear,
restlessness, poor attention, confusion, memory loss, mood changes including
depression, lack of co-ordination, appetite loss, weakness, insomnia, muscle
tremors, disorientation, learning disability, apathy, fatigue, heart
disturbances, problems in nerve conduction and muscle contraction, muscle
cramps, and predisposition to stress, to name just a few! (59 – 62) Note that
many of these symptoms are common to ADHD.
Is Mg deficiency common enough to think that it might play a role in
difficulties with attention, memory, learning abilities, restlessness, etc.?
Actually, most people in the Western world are probably at least marginally Mg
deficient. Dietary surveys show women on typical Western diets to average
175-225mg Mg/day, men 225-275mg Mg/day. A typical modern “junk food” diet,
consisting primarily of soft drinks, hot dogs, hamburgers, white bread, French
fries, cheese, pastries, candy, pizza, snack chips, etc. might fail to provide
even 200mg Mg/day. The RDA for Mg has been set at 300-400mg/day. Yet Mg “guru”
Mildred Seelig, M.D., has done extensive research which indicates that 8mg/kg
bodyweight is probably a more optimal intake level. (63) This would be a
560mg/day requirement for a 70kg (154 pound) person.
In addition, there are many factors that impair intestinal absorption of
Mg. High intake of phosphate (common in meat, soft drinks and baked goods)
calcium, fat, phytate (found in unleavened bread and wheat bran), lactose (milk
sugar), oxalate (found in spinach, rhubarb, chocolate), and alcohol, as well as
laxative abuse, all inhibit intestinal Mg absorption. (53, 59, 60) Healthy
kidneys may reabsorb up to 95% of Mg before it is lost in the urine, yet many
factors promote Mg urinary loss: the stress hormones adrenaline and cortisol,
diuretics (including caffeine), some antibiotics, digoxin, alcohol, high
sodium/calcium/sugar intake (i.e. the typical western diet) and birth control
pills, among others. (53, 59, 64) Thus anyone who lives the typical modern
high stress/ high fat and sugar/ high soft drink/ high coffee and alcohol
lifestyle may be an appropriate candidate for Mg supplementation, with increased
focus, attention, stress resistance, memory and learning powers as possible
benefits. However, Mg repletion at the cellular level is a slow process, and may
take weeks to months to achieve maximum benefit. Most people can safely
and beneficially take 100 – 200mg Mg 2 – 3 times daily (with some at bedtime for
insomniacs). If diarrhoea develops, reduce dosage and /or frequency.
Anyone with serious kidney disease should check with a nutritionally
knowledgeable physician before adding Mg. Best supplement forms are Mg malate,
orotate, succinate, taurinate, glycinate and chloride.
NOOTROPICS FOR ALERTNESS & ATTENTION
Nootropic drugs are one of the premier classes of proven anti-aging drugs.
They are especially effective at enhancing memory, alertness and attention. The
concept and definition of a nootropic drug was first proposed by Giurgea in
1973. The characteristics of a nootropic drug include:
1) Enhancement of learning and memory (and concentration is the gateway
to learning and memory);
2) Enhancing the resistance of learning and
memory to conditions which tend to disrupt them (e.g. Electroconvulsive shock,
poor brain blood flow);
3) Protection of the brain against various
physical and chemical injuries (e.g. barbiturates, scopalamine);
4) Lack of the usual pharmacology of other psychotropic drugs (e.g.
sedation, stimulation, restlessness, etc.) and possessing very few and only
minimal side effects and very low toxicity. (68)
Considering that concentration is a whole-brain activity, that decreased
brain blood flow and energy metabolism (especially in the frontal lobes) is a
key element in decreased attention, and that “deficit of attention is among the
most common consequences of brain damage” (36) the following nootropics are
excellent aids to enhanced focus and attention.
VINPOCETINE
Vinpocetine (VPC) is a slightly altered form of vincamine (VCM), an alkaloid
extracted from the Periwinkle plant, vinca minor. In use for almost 30
years, research has gradually shown VPC to be the superior vinca alkaloid,
having few and minor if any side effects, with a greater range of metabolic and
clinical benefits than VCM. VPC has been shown to be a cerebral metabolic
enhancer and a selective cerebral vasodilator (i.e. one which increases blood
flow only to brain regions where it is compromised). (69, 70) VPC has been
shown to enhance oxygen and glucose uptake from blood by brain neurons, and to
increase neuronal ATP energy production, even under hypoxic (low oxygen)
conditions. (71, 72) Both animal and human research has shown VPC to
restore impaired brain carbohydrate/energy metabolism. (69, 73)
An important objective measurement of impaired concentration and alertness is
the EEG (electroencephalogram) record. In 1991 J. Lubar published his results of
15 years of EEG research on ADD subjects. Comparing ADD children to normal
controls, he discovered that ADD children “…produce excessive theta activity
in the 4-8 Hz [cycles/second] range and were particularly deficient in beta [14
Hz and above] production …. Specifically, increased theta activity was
obtained in many [brain regions] particularly frontal and centrally ….
Decreased beta activity was found in many frontal and temporal locations.”
(74) EEG is a measure of brain electrical activity. Theta (slow wave
activity) is typical of deeply sedated mental states, while beta is associated
with concentration and focused mental activity. Saletu and Grunberger
report that “Human brain function as measured by … [EEG] shows significant
alterations in normal and pathological aging characterised by an increase of
[slow wave] delta and theta activity and a decrease of alpha and … beta [fast
wave] activity…. These changes are indicative of deficits in the vigilance
regulatory systems. By the term vigilance we [mean] the …dynamic state of total
neural activity [remember &endash; concentration is a whole brain activity] …. Elderly
subjects with bad memory exhibit slower [EEG] activity and less … beta activity
than those with good memory …. nootropic drugs such as … vincamine alkaloids
[VPC & VCM] induce interestingly just oppositional changes [to the
age-related slowing of EEG waves] in human brain function, thereby improving
vigilance [and attention].” (75) Two things follow from this:
1) both the normal and pathological aging brain become more and more
like an ADD child’s brain; and
2) VPC can reverse these ADD-like brain
states to more normal alert and attentive brain states!
VPC has very few side effects and is extremely non-toxic (76), although some
experts caution against its use in pregnant women. (76) Gastric upset, increased
heart rate, and skin rash are the main (rarely occurring) reported side effects.
A dose of 2.5 to 5mg 2 to 3 times daily is generally safe and effective.
Taking VPC right after a meal reduces chance of gastric upset.
PIRACETAM
Piracetam (PIR) is the original nootropic drug, for which the category was
first defined. (68) PIR is one of the least toxic drugs ever discovered:
“Piracetam is apparently virtually non-toxic …. Rats treated chronically with
100 to 1,000 mg/kg orally for 6 months and dogs treated with as much as 10 gm/kg
orally for one year did not show any toxic effect.” (77) For a human
equivalent, 10 gm/kg would be 700 gm (11⁄2 pounds!) for a 70 kg (154 pound)
person. PIR has been shown to improve memory, EEG, alertness and mental
performance in a wide variety of human clinical studies. PIR restored
normal EEG and state of consciousness in people suffering acute and chronic
cerebral ischaemia (decreased brain blood flow). (78, 79) PIR has improved
alertness and IQ in elderly psychiatric patients suffering from “mild diffuse
cerebral impairment.” (80) PIR increased memory and verbal learning in
dyslexic children, as well as speed and accuracy of reading, writing and
spelling. (81,82) PIR has improved mental performance in “aging,
non-deteriorated individuals” suffering only from “middle-aged forgetfulness.”
(83) Elderly outpatients suffering from “age-associated memory impairment” given
PIR showed significant improvement in memory consolidation and recall (84), and
as Smith and Lowrey note in a study on concentration in elderly subjects,
“Concentration is intimately involved in the process of reception, storage, and
recall [of memories].” (85) Like VPC, PIR reversed typical EEG slowing
(which mimics the EEG of the ADD brain state) associated with normal and
pathological human aging, increasing beta (fast) EEG activity, while
simultaneously increasing vigilance, attention and memory. (86) In a 1987 study,
Grau and co-workers fed rats i.v. radioactive deoxyglucose to help measure brain
metabolism. Compared to saline controls, PIR rats had a 22% increase in
whole brain glucose metabolism, while the increase in 12 specific brain regions
ranged from 16 to 28%. The increase in brain energy metabolism occurred
under normal oxygen conditions. (87) And remember &endash; decreased brain energy
metabolism equals reduced focus and attention, while increased brain energy
metabolism equals enhanced focus and attention.
Typical PIR dosages range from 800 mg to 1600 mg 2 to 4 times daily. PIR may
(very rarely) cause headache, insomnia, over-stimulation or irritability. This
is most likely to occur in heavy caffeine-users, or those taking high doses of
other nootropics. I have personally used PIR continually for 12 years and
have never noticed any side effects from it. Along with VPC, it is one of my
favorite concentration-enhancing drugs.
DEPRENYL
Deprenyl, (DPR), also called selegiline, is a popular anti-aging
drug.
It is a potent neuroprotector. (88) It is also a selective MAO-B
inhibitor. (88) MAO-B is the neuro-enzyme that breaks down the neurotransmitter
dopamine (DA) and the neuromodulator phenylethylamine (PEA). DPR and its
“cousin” PEA are catecholamine activity enhancers (CAE). (88) Catecholamines
include DA, noradrenaline (NA) and adrenaline. DA and NA are the
neurotransmitters for the key activating brain circuits: the mesolimbic-cortical
(MLC) circuit and the locus coeruleus (LC). The MLC and LC both activate the
frontal lobes, and are critical for maintaining focus, alertness, concentration,
and effortful attention. (89)
The pioneering research of Dr. Joseph Knoll has shown DPR and PEA serve to
more effectively couple the release of DA/NA to the electrical impulse that
triggers their release, thus enhancing the activity of the MLC and LC attention
circuits. (88) DPR also increases brain levels of PEA dramatically.
(88) Baker and colleagues presented evidence in 1991 that a deficiency of
brain PEA may play a role in ADD, and that this may result in part from a
deficiency of the amino acid phenylalanine, the precursor of PEA. (90) A 1984
study showed a unique synergy between DPR and phenylalanine in treating
anti-depressant drug-resistant depression patients. (91) Thus a combination of
1.5 to 5mg DPR daily plus 250 mg phenylalanine may prove helpful to those who
suffer impaired concentration and attention connected with a “spacey,” “foggy,”
under-aroused state of consciousness. DPR has been shown to increase
attention, alertness and memory in various Alzheimer disease studies. (89, 92)
In some cases, DPR, with or without phenylalanine, may lead to over-stimulation,
irritability, or insomnia. Reduce dosage or discontinue if this occurs.
DMAE & CENTROPHENOXINE
Centrophenoxine (CPH), also known as Lucidril and meclofenoxate, is one of
the oldest nootropic drugs &endash; it was developed in 1959. (93) Imre Zs-Nagy, M.D.
the world’s most prolific CPH researcher, has called CPH a “brain metabolic
stimulant” and a “neuroenergeticum” &endash; i.e. a neuroenergizer. (93)
CPH “stimulates glucose uptake, oxygen consumption, and carbon dioxide
production in vivo [in the living organism] ….” (94) “…centrophenoxine can
stimulate cerebral electrical activity in the aging brain.” (93) Increased
brain metabolic and electrical activity are the basis for improved attention and
alertness. “Clinical studies with [CPH] in geriatric patients with such
symptoms as confusion … and disturbances of memory and intellectual
concentration revealed marked improvement after several weeks of treatment
…. Clinical studies in European literature have reported a significant
improvement of such symptoms as fatigue, irritability, confusional states [the
opposite of alert, focused attention] and improvement of memory in the geriatric
patients treated with centrophenoxine.” (95)
CPH is a combination of two other biochemicals &endash; DMAE (dimethylaminoethanol)
and PCPA (paarachlorophenoxyacetic acid). DMAE is a natural brain
constituent, closely related to choline. (93) CPH is, in effect, a
super-DMAE: “Pharmacokinetic studies of CPH revealed that … much higher levels
of DMAE were found in the brain after CPH treatment, as compared to DMAE, alone,
since apparently the esterified form of DMAE with PCPA penetrates much easier
the blood-brain barrier.” (94) This is significant, because DMAE was used
successfully to treat children suffering form “minimal brain dysfunction” (the
earlier name for ADHD) during the 1958 to 75 period, with increased attention
span as the result. (96 &endash; 98) Thus CPH can be expected to provide even
better results in improving attention.
CPH is considered an extremely non-toxic drug. (93) Doses used in human
clinical studies are typically 250 &endash; 1,000 mg twice daily (breakfast and lunch).
(93) For use in enhancing focus and attention span, where no major brain
pathology is present (that would increase dosage), 250 mg once or twice daily is
a generally safe and useful dose. Although CPH is generally safe and non-toxic,
there are a few precautions to its use. CPH is a powerful enhancer of
brain acetylcholine (ACh) levels. (93) Excessive brain/peripheral nervous
system levels of ACh can lead to headaches, neck/jaw/shoulder muscle tension,
insomnia, irritability, agitation and depression. This is NOT a toxicity
reaction &endash; it is simply too much of a good thing, ACh. If any of these
symptoms occur, simply discontinue CPH for several days, then try a reduced
dosage. Those especially sensitive to CPH may need to take it only on
alternate days to avoid ACh excess. Any persons suffering from major
depression, mania, seizure disorders or Parkinson’s disease should avoid CPH, as
too much ACh may worsen these conditions. Also, pregnant women should
avoid CPH.
PYRITINOL
Pyritinol (PYR) is a nootropic that had been in use over 40 years. PYR is
closely related to pyridoxine (vitamin B6), but it has no B6 activity.
(99) PYR is a compound of 2 pyridoxine molecules which are joined together
by 2 sulphur atoms. (99) “[PYR] has been shown to increase glucose uptake
and utilisation, tending to normalize or increase transport across the
blood-brain barrier. Oxygen consumption … and cortical acetylcholine release are
… improved by the drug. Nerve cells may be protected in cerebral deficiencies,
with cell membrane structures and functions undergoing improvement after damage,
and regional blood flow increases [after damage]. Pyritinol has also been
shown to produce a vigilance [alertness] response, both behaviourally and
electrophysiologically (EEG recordings) in animals and healthy human volunteers
….
Clinical research has shown that pyritinol 600 &endash; 800 mg per day is effective
in improving … activity, alertness, mental power, interest and emotional
stability in individuals suffering from mental insufficiency and clinical
dementia. (99) In a South African study on PYR with hyperkinetic and
learning-disabled children, it was noticed during the placebo-controlled trial
that “… 8 children in one of the [test] groups were making great strides in many
ways: drive, alertness and concentration were improving …. These 8 pupils were
all in the [PYR} group.” (100) In a study of PYR in senile dementia
(Alzheimer and stroke dementia), “… EEG mapping demonstrated significant
differences between placebo and pyritinol, with the latter decreasing slow
[theta/delta] and increasing fast alpha and beta activity, which reflects
improvement of vigilance [attention].” (101) PYR is generally a very safe
nootropic, with few and mild side-effects. (101, 103) However, in a study
of those suffering severe rheumatoid arthritis and taking high dose (600
mg/day) long term (1 year) PYR, there was a 2% incidence of serious
side-effects. (102) For those wishing to use PYR to enhance general brain
function and improve concentration, 100 mg once or twice daily (breakfast and
lunch) is a reasonable dosage regimen.
CONCLUSION
As this article has indicated, concentration is a function of whole-brain
activity and health, and impaired attention is a natural consequence of any
brain damage &endash; structural or functional. For most people not suffering any major
brain damage or pathology, simply adopting a high protein/ low sugar and refined
carbohydrate diet, combined with a good B complex vitamin, Mg, CoQ10 or
idebenone, and lipoic acid, will promote improved focus, alertness and attention
span.
For those wishing to “go the extra mile,” adding one or more of the
nootropics discussed above will usually provide even further benefit. I have
personally interviewed many (more or less) healthy people who use one or more of
these nootropics in their health regimens, who have found noticeably enhanced
alertness, concentration and memory.
I have used nootropics for many years to aid in the intense concentration and
focus I need to get through the dense, technical, tedious and often boring books
and papers I have to read to write my many anti-aging/ nootropic / nutritional
articles. They do work!
Copyright 2003. This article may not be reproduced for public
broadcast in any form, without the written permission of: International Antiaging Systems
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