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ADHD Plus: Dr. Charles Parker On Thyroid, Diet, Hormones, SPECT — And ADHD Meds

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Live a few decades not knowing that you have ADHD, and chances are you’re lugging around not onlyDr.  Charles Parker emotional baggage but also physical baggage — sleep debt, adrenal exhaustion, off-kilter hormones, allergies, and more. Yet, in our specialist-dominated healthcare “system,” finding a physician who can assemble all the puzzle pieces is a challenge.

When’s the last time your personal physician, not to mention ADHD-treating psychiatrist, closely scrutinized lab results for your complete blood panel, adrenal function, or hormones and could properly answer your questions about, say, potential gluten sensitivity? Yet, if you’re suffering from any of these allied health challenges, your brain function could be suffering in ways that will never be sufficiently addressed by psychotropic medications alone.

A few years ago, I scoured the Internet for a “big picture” physician who was sharing information (on a blog or website) not only about ADHD and its commonly co-occurring conditions but also the many other biomarkers that affect brain health. Fortunately, I found CorePsychBlog , written by physician, author, neuroscientist, and psychiatric consultant Dr. Charles Parker (pictured, above right). (Regular readers of this blog have seen Dr. Parker’s comments. For the record, he and I have never met and have no business association.) Pick your media preference: written posts, radio shows, or videos. CorePsychBlog is packed with information. So packed that I’ve picked out a few highlights to get you started (in a follow-up post, I’ll share links to some of Dr. Parker’s highly informative videos):

Metabolic Moments and Nutrition in Evidence: “If your metabolic body is rusty or broken, your brain drifts downstream in the swill,” says Dr. Parker. “Not a pretty sight on the short term, devastating over the years.” Learn about insulin resistance, adrenal fatigue, estrogen dominance, Polycystic Ovarian Syndrome (PCOS), fibroids, endometriosis, and more.

Getting the ADHD Meds Right: “If we start with the right diagnosis, and recognize complexity of the spectrum of ADD, we will be much more capable of finding the right solution,” says Dr. Parker, introducing the first in a three-episode series regarding right diagnosis, right meds, wrong meds, and metabolic issues that encourage a failure of treatment.

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  1. Dr Charles Parker’s avatar

    Gina,
    Early this morning up to find your kind piece on my mission over at CorePsych [actually mine is very close to your objective over here] – and am so appreciative of your taking the time to send this note to your crew. It’s been most reassuring out on my perch to listen to your exceptional voice, your keen insights, and your engaging sense of humor about matters that are so regularly misunderstood out on the ADHD road to recovery.

    Confusion often prevails where common sense and the evolution of mind science appear to have taken a vacation.

    Most of all I appreciate your fresh, uncomplicated take on matters that may at first appear just too complex – and, even though we have never met, it seems like we have been friends for many years. In speaking with Russell Barkley at a recent meeting I quickly discovered you have that effect on many of your colleagues – and I thought it was just me ;-)

    Thanks so much – look forward to our evolving conversations!
    Chuck

    Reply

  2. David L.’s avatar

    Hi Gina and Dr. Parker,

    Gina referred me to Dr. Parker’s blog a couple years ago. As if it’s not hard enough to have ADHD and to deal with (mis)managed care in trying to get ADHD treatment, it’s IMPOSSIBLE to find one physician who could “connect the dots” between my low thyroid, heart arhythmia, itchy skin and more. Reading Dr. Parker’s CorePsychBlog validated many of my concerns and motivated me to keep looking for answers. Thanks to both of you!

    David

    Reply

  3. Glenna A.’s avatar

    Go Gina Go!!!

    Thanks so much for digging until you found a doctor who is writing and blogging about ADHD and its traveling companions. I have long struggled with this issue with close to no help from my doctors.

    I have done my own research and tentatively begun to solve my own physical problems with ADHD, thyroid insufficiency, allergies, asthma, fibromyalgia and rheumatoid arthritis. All those conditions are related, who knew? Certainly not my esteemed docs.

    Glenna

    Reply

  4. Danelle’s avatar

    I’m confused as I come across this post and have found nothing with Dr. Parker that clarifies. Are you (him) saying that ADHD can be the cause of the other conditions, or the other way around? I have been diagnosed with gluten sensitivity, metabolic syndrome, low thyroid, and estrogen dominance, and adrenal exhaustion (extreme fatigue). 2 of my children have been diagnosed with ADHD, therefore I’m wondering if it came from me–but I don’t fit the classic symptoms of ADHD more than just mildly. Nothing seems to be working to help the other conditions (progesterone cream, compounded thyroid meds, no carb/sugar diet) and I’m wondering if a stimulant will help.

    Reply

    1. Gina Pera’s avatar

      Hi Danelle,

      I understand your confusion. We humans are complex creatures, and the brain is the most complex part of us!

      I have an ongoing bone-problem in my foot, and I cannot find two specialists who can agree on what to do next. The orthopedic surgeon has one idea. The Podiatric Surgeron has another. The physical therapist still another opinion. And on and on. With none of them seeming to even “talk the same language.”

      If it’s this bad with a simple, mechanistic problem, think about the brain =- and all the possible conditions that can affect brain problems. Shew!

      If you have two children with ADHD, chances are good that if the biological father doesn’t have it, you do. If the physician who prescribed the progesterone, the thyroid medication, the diets, etc. doesn’t know about ADHD, it won’t even come up as a possibility.

      But yes, living a few decades with untreated ADHD can also create “side effects” in hormone and thyroid function (from the stress, from the lack of sleep, from the erratic diet, from lack of exercise). So, it’s a big complicated ball of wax!

      Some people find that only after starting on a good regimen of ADHD medication can they start untangling the rest of these issues. So, maybe it’s time for you to pursue an evaluation for ADHD and try treatment for that. Especially if nothing else has worked. (Then again, there is no reason to think that a no carb diet will work for ADHD, and can even make symptoms worse. Perhaps this is something you decided upon yourself and not with the help of a physician.)

      Good luck,
      Gina

    2. Danelle’s avatar

      Wow, thanks for the response. I will forward this to my MD who happens to be a holistic doctor. She recommended the no-carb diet (as did several others) due to metabolic syndrome. I gain a lot of weight when eating refined carbs and even fruits. Thanks again!

      Reply

    3. Collin Prodan’s avatar

      Adrenal fatigue is a term applied to a collection of nonspecific symptoms, such as body aches, fatigue, nervousness, sleep disturbances and digestive problems. The term often shows up in popular health books and on alternative medicine websites, but it isn’t an accepted medical diagnosis.

      Reply

    4. Michele’s avatar

      I am a 44 year old mother of 4 who has had ADHD symptoms (hyperactivity, impulsivity, distractability, lack of focus..) I started a med for the first time 10 years ago ( adderall) and it helps greatly. A year ago I began having fatigue and my TSH was 11; T 3 and T 4 were normal; iodine was high. I started on nature thyroid and felt better; my doctor said I needed to stop the adderall as this was a cause of the hypothyroid. I weaned off; after a few months all my ADHD symptoms as well as anxiety about it became high: I was chugging coffee, energy drinks, supplements to increase focus and energy like crazy… Thought this is nuts and found another doctor to put me back on the adderall. So now I take both adderall (15 mg ER in morning; 20 mg regular in afternoon) and 65 mg of nature thyroid in am. Am I damaging my adrenals or causing greater thyroid issues by continuing to take the adderall? I am Classic ADHD and am fearful at the thought of being without the adderall. Please respond – this is a major concern as I do not want to damage myself long term from a stimulant!
      Thank you !

      Reply

      1. Gina Pera’s avatar

        Hi Michele,

        I am not a physician, so I cannot offer medical advice. Of course neither can a physician without examining you.

        But I will share my thoughts, based on what I know of these issues.

        1. I’ve never heard that Adderall (or any other stimulant) causes hypothyroidism. Perhaps that doctor is unfamiliar with ADHD-related neurobiology.

        2. Many women develop hypothyroidism in the 40s (sometimes higher). In other words, this could have happened independently of the Adderall. You are the mother of four and a personal trainer; is it possible that you are pushing yourself too hard? It might not feel “normal” to you to be a little more sedate than you were in your youth, but it might merit some thought.

        3. The amphetamine class (AMP) of stimulants do operate a little differently than the methylphenidate (MPH); there is an extra mechanism that serves to sort of “squeeze out” more from the cell. I’ve known many people to feel exhausted after 2 months on Adderall, perhaps for that reason. Or the next.

        4. It’s very important not to mistake the “rocket fuel” that Adderall can be for some people with your natural energy levels. In other words. some people with ADHD finds that Adderall makes them super-productive and so they go into over-drive. Ideally, stimulants should work to help you balance your life, not be a super-charged Energizer bunny. It’s important to rest, to get plenty of sleep.

        5. If you haven’t tried Vyvanse, you might want to. From many reports, it seems to work better than Adderall for the people who like Adderall (and even some who don’t), but the delivery is more smooth and sustained, less exhausting. (For others, of course, this is not true.)

        6. The brain sends signals to the other organs to produce hormones, etc. In other words, the brain regulates other physiological processes. It makes sense to me that the brain of person with ADHD would be better able to regulate these process when medication is in the system. Because the medication helps to regulate the brain function itself.

        If it were me, I’d monitor my thyroid levels and see if the Adderall worsens/improves.

        Oh, one more thing: You said your iodine was high. Most people have iodine deficiency. So, perhaps there is some risk to thyroid function of having too much iodine. And you could try laying off whatever you are eating that contains iodine?

        good luck!
        g

      2. Michele’s avatar

        Oh one more comment – I was definitely ADHD in childhood just never identified or treated – used sports to channel my energies and still do today as a persona trainer. Using a stimulant for the first time was like putting glasses on!

        Reply

      3. Michele’s avatar

        Wow thanks g for your helpful comments. Regarding my iodine levs, I supplemented with it for a while hence the elevated levels. I avoid it now and would never supplement with it again – in fact I feel no one should without first testing their levels – and have learned high iodine levels may in fact throw one into hypothyroidism! Slow thyroid does run in my family and being a high energy person I am sure I have contributed to it with my habits.
        Regarding vivance – yes I have tried it. I feel an unbelievable calm on it; I did like it and yes it could be better for me – only one big problem – it constipated me! It was the vivance and do not think it’s an issue that I could deal with. I can try to take it again – you are right – it’s definitely not the rocket fuel feeling and I find I really like that feeling – that may be a huge issue with me and again, one that has led to the hypothyroid.
        I thank you again for your thoughts, I will consider the vivance again. And yes try to slow down, get more sleep ( close to impossible with 4 kids) and rest more… Also hard for me!

        Reply

        1. Gina Pera’s avatar

          Hi Michele,

          Constipation, eh? That’s a new one!

          You could try taking some magnesium citrate while you’re taking the Vyvanse. Probably would help you feel calmer, too.

          The “rocket-fuel” feeling is how many people with ADHD who take Adderall know that it’s “working.” At least they think they do. Actually, I consider that a huge problem with Adderall; the visceral “it’s working” feeling. It’s better to use more objective criteria regarding your functioning and thinking, now just feeling that someone lit a rocket under your behind. :-)

          g

        2. Dr Charles Parker’s avatar

          Michele,
          Gina does a great job of breaking down much of the complexity – and she’s right on about the various AMP and MPH meds.

          Some notes:
          1. Right: no evidence of problems with stimulant meds of any kind with hypothyroidism… except the following:

          a. Meds may cover an underlying adrenal or thyroid problem by pushing the person through real medical symptoms that require more deliberate medical attention.
          b. With associated medical problems meds are oftentimes difficult to adjust because the energy issues and cognitive issues [that the ADHD meds are designed to treat] often overlap.
          c. Most often thyroid issues occur downstream from other metabolic issues, and, as one person commented above, associated additional adrenal issues, [though not considered real in the subtle presentation of "fatigue"] do respond to precise diagnosis and treatment even though traditional medicine, focused more on life and death than brain function, may disagree.
          d. I also agree with the concept that longer acting meds would likely prove helpful, but the everyday reality of managed care with their pervasive lack of appreciation for the nuances of medication compliance with multiple dosings add further treatment complexity.

          Adrenal problems with both thyroid problems and ADHD further complicate the complexity and require more comprehensive, coordinated diagnostic and treatment efforts.

          You are not damaging your adrenals or thyroid unless you simply use ADHD meds to get through the day and overlook treatment of the other conditions. They will likely evolve if not correctly addressed.

          Testing proves useful, and a commonplace oversight is missing immunity issues such as food sensitivities which leading authorities internationally, and at, for example, Harvard, consider essential to review.

          Testing will provide additional maps for these new territories.
          Best of luck in your next steps.
          cp

          Reply

          1. Gina Pera’s avatar

            Thanks for weighing in, Dr. Parker!
            g

          2. Sunette Terblanche’s avatar

            Hi,
            I am a 37 year old mother of 2 (3 and 5 year old). I’ve been on antidepressant meds since I was diagnosed at 16 and since then have learnt the hard way that I should not go without it. About 2 years ago I suggested to my psychiatrist (I’ve been a patient of hers for about 7 years now) that I suspect I have ADHD and she agreed that she’d noticed the symptoms. She put me on Concerta which worked wonders, like Michelle said using a stimulant really was like putting on glasses!

            I currently work as a process engineer and wish a had the help of a stimulant during my studies – I really had a very difficult time with my symptoms back then. That said, it was as if becoming a mother (pregnancy, sleep deprevation, added responsibilities and worries etc) caused the ADHD symptoms to really crystallize out into something that couldn’t be missed.

            My question is about fatigue. Even with 36mg of Concerta per day I still suffer from chronic fatigue and after a day at the office/on site I have trouble facing my family with all their needs – this makes me feel extremely guilty. I love them to bits but I also enjoy my job (and we really do need the income) but it feels like it is all just too much for me. I’m not sure if I’m depressed because I’m tired or tired because I’m depressed! ADHD is OK as long as I take my Concerta.

            I went to see a medical doctor in February this year and she had some blood work done. Consultation fees plus cost of the blood work was about half a month’s salary (!), even if I have health insurance, just because it is not considered as conventional medical expenses. The doc said my blood serotonin is severely low, and something called a Braverman assessment indicates very low serotonin, GABA and dopamine. I haven’t gone for the cortisol test but she highly suspects my adrenals not working well also. She gave me a script for supplements (which she sells) costing another 15% of my monthly pay check for a month’s worth, nothing covered by medical insurance because of its alternative nature. I felt distressed and simply freaked out about all that was now wrong with me and the cost to make it better.

            Before filling the script I asked my trusted psychiatrist’s opinion, she said looking at blood serotonin is useless and she is very skeptical. After considering a few things we decided to try switching to Sertraline as an alternative antidepressant. I was on Cipralex/Lexamil before but we thought it may have been making the fatigue worse. The Sertraline is working OK (I am still deciding about this) but even with that change I would not possibly be able to cope without the Concerta, and this concerns me.

            I read Dr Parker’s book on ADHD meds and I think I’ve got my dosage right now. I have eliminated gluten from my diet and mostly stick to a low carb, high protein diet, with lots of healthy fats. It helps, but it didn’t solve the problem (I have committed to this way of eating in any case, I find it very beneficial on many levels).

            Do you think I am missing something here, some reason for the chronic fatigue which may or may not be linked to my depression and ADHD also? Is there any hope of treatment which is actually effective and affordable? I am so done with everyone offering so called solutions! I can’t afford to “play around” anymore but I really need to be healthy for myself and my family.

            Sorry for the long letter, that’s just typically me. Any advice?

            Thanks :)

            Reply

            1. Gina Pera’s avatar

              Hi Sunette,

              It’s hard to say what is causing your chronic fatigue. There could be many things, including your diet. High protein is not typically a healthy diet. You should not eat more protein than you need, and the rest of your diet should include healthy fats, complex carbs, and some fruits. Are you getting enough sleep? The fact that you don’t even mention sleep suggests that this might not be a priority?

              I don’t know the Braverman test, but you can’t measure serotonin. Only biomarkers for serotonin can be assessed, to varying degrees of accuracy.

              I’d say your psychiatrist should be working with you to tease out the issues. Do you really have chronic fatigue or are you overwhelmed with all of the tasks on your plate? Your psychiatrist or therapist should be working with you on organizational strategies.

              I know that when I am overwhelmed and feeling I’m not up to the task of all that must be done, I too can feel exhausted.

              Developing a monthly schedule to tackle domestic tasks might help you to feel less stressed and overwhelmed.

              Good luck!
              Gina

            2. MjHacking’s avatar

              I live in Mass, getting ‘Crisis’ help for someone who has been on Meds 15 yrs, effectively,(Never pushing the dose, btw), is a (6) SIX month waiting period for meds from intake to issuance of a Pyschiatrist. That in itself is mind boggling to me, but there are no (very few) direct patient/Pyschiatrist relationships anymore.
              Mass has a System where because, ” I don’t want to hurt myself”, I get basic insurance that only Behavioral Health Mgmnt Agencies accept. PC Dr ‘s ‘I was Told’ the DEA prohibits writing scripts for chronic issues, only Pyschiatrists can, but directly, don’t accept my ins., cannot take cash, nor can I legally pay in cash. This leaves me with a PCA, & still a 5-6 month wait ,(My dr of 10 yrs retired btw,) E-Room refuse to write scripts, and my Wife’s PCA, (For reference) the. 4 th in 12 months , has written scripts for meds she already had severe adverse reactions to. So even when or if I get a PCA, scares the H #%^ out me , as I suffer from specific Adult ADHD,& Anxiety Disoder- complexities. The major one is the Metabolic coding for ADHD, (I don’t keep it in my body as long as other people it just gets expelled through. ” Ive been told is ‘renal Discharge /cleansing of the med’, so a 30Mg IR tab (Which gives me NO ROCKET effect, in fact if I don’t spread my doses right I get groggy, only lasts 2-3 hrs!). That’s my base story, my question is I take 90mg IR 30×3 a day (I work for a huG e..co, as a Photographer/ & cannot NOT complete work, so I work. 10-12 hr days. When Vyvanse 70mg was out I went from 90Adderall XR to 70mg Vyvanse & it was a wonder drug. 6 months later I saw the rocket effect & asked to go back, I did for 23 days. Even calling Shire for help, finally called my Dr.(On Vacation-He was pissed) put me back on Adderall and wouldn’t discuss how to transition. I feel like 3weeks should have been plenty for me to be able to function, but I couldn’t. My anxiety has increased and I’m counting my pills all the time, remembering the misery of those 3 weeks, do I have any chance? ThankYou

              Reply

              1. Gina Pera’s avatar

                Ach, I’m sorry it’s so hard, MJ!

                I’m not sure of your question, though.

                I’m not sure why you stopped the Vyvanse (“I saw the rocket effect” – what? dimninish? At any rate, you don’t want a rocket effect; you want a steady effect).

                You asked to go back to Adderall, to get the “rocket effect”? (Again, bad idea.)

                What kind of transition, from vyvanse to Adderall?

                In general, you just can’t burn the candle at both ends. So, if you are using these medications as one would “speed,” it’s just not going to work over time. You will become depleted, in many ways.

                Most adults with ADHD have a co-existing condition — including anxiety. And that can be exacerbated by the stimulants if it is neurogenetic anxiety and not anxiety from untreated ADHD. Many people take a medication for anxiety in addition to the stimulant. For some, Strattera plus a stimulant fulfills that dual-goal.

                Obviously, creating better efficiency at work should be a top priority. Can you get some help with that?

                g

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