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

Live a few decades not knowing that you have ADHD, and chances are you’re lugging around not onlyDr. 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, hormones? How about properly answering 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.  But will your physician understand this?

Unfortunately, I’ve found many ADHD medication prescribers don’t even get the basics right with that. How can they possibly understand the individual factors around drug metabolism,  side effects, nutrition, supplements, hormones, and all the rest?

A few years ago, I scoured the Internet for a “big picture and small details” physician. I sought a 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 Charles Parker, D.O. (pictured, above right). (Regular readers of this blog have seen Dr. Parker’s comments. For the record, he and I  have no business association.)

Update: This post dates to 2009

Dr. Parker has since scaled back his blogging and other writing. You can still watch many of Dr. Parker’s videos on Youtube.

On 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.

 

38 thoughts on “ADHD Plus: Dr. Charles Parker On Thyroid, Diet, Hormones, SPECT — And ADHD Meds”

  1. 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 🙂

    1. 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. 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

  3. 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!

    1. 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

  4. 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

  5. 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.

    1. Adrenal fatigue is real I have it along with Hashimoto’s and leaky gut . I’m so weak I can’t function. I’ve seen a md who also does the natural route With supplements. I’ve gone gluten free dairy free the whole 9 yards I still feel like terrible. I take armour thyroid meds . This is going on 11 months with very little improvement .

    2. Hi Terry,

      I’m sorry that you’re struggling physically. I know what that feels like.

      Yes, the feelings associated with so-called “Adrenal Fatigue” are real. But that is not a diagnosis.

      https://www.health.harvard.edu/blog/is-adrenal-fatigue-real-2018022813344

      I’ve found the term used more by “alternative” healthcare providers—and often with a ton of supplements and all the usual remedies du jour (e.g. methylated folic acid, gluten-free, etc.).

      If over 11 months you have little improvement, I hope you can change tactics.

      You don’t mention if you have ADHD and, if so, you are taking medication. It might make a big difference for you.

      Good luck sorting this. I know it’s hard to have to manage one’s own healthcare when feeling so non-functional.

      gina

  6. 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!

  7. 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.

    1. 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. Danielle, read the site of Mensah Medical-www.mensahmedical.com
      Your symptoms are in line with copper
      Toxicity: possibly also
      Pyroluria and a methylation issue has
      Well. The two
      Doctors at Me say can tie things in – they are brilliant. And you can start
      With
      Getting
      Tested
      At
      Home and having a phone consult. Believe me
      – they are your
      Answer and only hope! They have greatly helped so many with. Issues like yours…

    3. Hi Michele,

      Thanks for your comment. I’ve been interested in the work of the docs at Mensah Medical. Their philosophy is largely in line with Bill Walsh, I think. Food for thought.

      There are so many things standard psychiatrists and MDs miss. When symptoms elude standard treatments, we must dig deeper.

      g

  8. 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

  9. 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

  10. 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

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