Are ADHD Medications Safe for Kids?

I see a troubling trend in the pharmacy that has been going on since I started working with a license. And it’s probably no surprise since if you clicked on the link, you already know what I’m going to be discussing today.

ADHD? No problem. There's a pill for that.

ADHD? No problem. There’s a pill for that.

I see kids as young as 3-4, yes that’s right, 36-48 months of life, on ADHD medications. That’s quite interesting to me. I’m not going to be discussing the idea that ADHD might not be real. I will discuss the drugs and implications.

The story usually goes something like this:

A child has a lot of energy and can’t focus in school. Parents of said child get a note or call from a teacher about the disruptions, lack of attention, not working on assignments etc. Mom takes a child to doctor and, after performing some routine tests (at least we hope so), mom receives a prescription for some Ritalin, Adderall or other stimulant, goes to the pharmacy and gets to talk to the pharmacist.

This is where more truth comes out because we pharmacist have to disclose more information than a doctor typically would, or would want to. Side effects include; dizziness, sleepiness, decreased appetite, weight loss (that’s why meth addicts are so skinny), high blood pressure, arrhythmias, seizures, priapism, growth suppression, nervousness, insomnia, tachycardia, nausea, headache, palpitations, and visual disturbances.

Truth be told, many people like the effects of stimulants because they get you going, help you feel good, and can hit the pleasure centers of the brain to cause euphoria and if used long enough, or if the effect is strong enough, addiction.

I’ve talked with moms who’ve seen some of these effects in their children. The most common is weight loss and lack of appetite, which go hand in hand. Many also have nausea, compounding the weight loss problem.

What’s worse is that many are getting antipsychotic medications and/or anti-anxiety medications. We’re talking the big guns like benzodiazepines (Xanax, Ativan, Klonopin) and dopamine blockers (Risperdal, Seroquel, Geodon). According to a report from Columbia University, rates of antipsychotics have doubled in children ages 2-5 from 2000-2007. [1]

What’s worse is that less than half of these children actually had any kind of mental health evaluation, visit with a psychiatrist or have a psychotherapy visit.

One story of an 18 month old, yes 18 months, can be read at the New York Times [2] about how he was prescribed medications for temper tantrums. His condition got worse until his parents and some good doctors were able to wean him off everything other than some Vyvanse (a stimulant for ADHD).  He was overweight and his mother described him as having “blankness” in his eyes by the time he was three.

Part of the problem may be that our public school system is a one size fits all approach to students. We try to fit some square students into a round hole approach. For some children, the public school system works well, especially with good parent involvement. For others, it fails them horribly. I have no data to support the idea that a change in paradigm with public schools’ approach to education might actually curb the rate of prescribing of these medications, but I think it would.

That’s for another post though.

This type of problem solving is analogous to a report I heard on NPR recently about nursing homes and long-term care facilities. A team went to discover if the residents in these types of facilities were really demented and had other mental health problems. Many residents of these types of facilities will yell out and make other types of disturbances during the day and night.

The tea tasked itself with discovering if their really was mental illness or something else going on. In one instance, a woman would yell out at night. Many times in this type of situation, nurses will administer depakote (an anti-seizure medication) or benzodiazepines to calm a patient down.

This team tried to communicate with her. What they found was, after some time and effort, was that she was cold at night. They got her a blanket and she calmed down and slept, all without medications.

Communication: what an amazing concept!

Rather than not listening to yelling and grunting and crying, we should listen and see if we can discover the real problem

Rather than not listening to yelling and grunting and crying, we should listen and see if we can discover the real problem

Now I know some people do legitimately have mental illness, there is no doubt about it. Getting a proper diagnoses from the proper channels is important though. Immediately throwing a drug at a problem is a mentality that unfortunately, too many doctors and patients and patient’s moms have. Working through a problem rather than throwing a tablet at it is harder, but can be worth it. Avoiding problems like the story in the New York Times is advisable.

Proper nutrition and activity is generally a good idea, especially for very active kids. Some kids are content to live in their brains more so than others. Others just can’t sit still. They need to move.

A child’s brain is also continuously developing. To address problems like ADHD at 2 or 3, or a temper tantrum at the same age is probably very premature.

My little 3 year old gets frustrated sometimes because she desperately wants to say something. Even when my wife or I is listening intently she’ll get mad or begin to cry. When asked the problem her reply is usually, “I just don’t know how to say it.” Her vocab isn’t quite up to par so her mode of expression goes from words to crying. I certainly don’t fault her for being unable to adequately express in words what’s she’s feeling at the age of 3.

If you think your child may have problems with ADHD and want to take them to a doctor, that’s fine. I don’t disagree with that. But a psychological evaluation by a professional recommended by the doctor is a good place to start. In some cases, if medication is needed on top of a healthy diet and activities, there are alternatives like clonidine which can be prescribed that don’t carry some of the risks of stimulants, or the potential abuse among children or their friends.

CIAO

 

1.Olfson, Mark, et al. “Trends in antipsychotic drug use by very young, privately insured children.” Journal of the American Academy of Child & Adolescent Psychiatry 49.1 (2010): 13-23.

2.http://query.nytimes.com/gst/fullpage.html?res=9D02E0DE1E3CF931A3575AC0A9669D8B63

 

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College Students and their Health

When I first attended college back in 2003, the types of food I was eating, or seeking out, was not on the top of my priority list, and it certainly didn’t cause me to think how it might affect my health. I’m willing to bet most people don’t think about their food choices when they are in college, unless they are in a nutrition degree or some other health related course of studies.

Slice em up good! Sweet Potatoes are a great source of nutrition, can be filling, and are super tasty.

Slice em up good! Sweet Potatoes are a great source of nutrition, can be filling, and are super tasty.

This is broad and I’m sure there are others who do take care of themselves. I am speaking from personal experience though, and I can say that there aren’t many that I knew who were really taking into consideration what they were eating. Unless of course they were trying to lose tons of weight, or put on lots of muscle.

I do remember eating lots of whatever Costco had to offer in the way of baked goods for breakfast. A Costco blueberry muffin after all is big, tasty, and no cooking is required. When on sale, I could get frozen pizzas for $1 and after 15 minutes, I had a toasty pizza. In honesty I tried to eat half, because hey, it’s a pizza. My stomach petitioned for more though and more times than not I would oblige. Both examples were calorie rich, but nutrition poor.

It’s no wonder to me why so many will gain the “freshman fifteen”, or the 10-15 pounds of body weight that accompanies so many new students.

A study done looking at what the authors call “food insecurity” looked at students and determined, based on surveys, that they had poor access to nutritious food, either by limited funds or uncertainty. [1] The study, done in Australia, found that students who worked, relied on family, or received government aid, were more insecure than those who were financially able. As many as 25% even experienced hunger.

The study also found that the food insecurity was higher in college students than the general population.

A study in Hawaii found that as many as 45% of students experienced this food insecurity. [2]

Yet another study found similar patterns to the one in Australia, that students with low-income, low GPA’s, having fair/poor health, or working all have higher rates of this food insecurity. [3]

It could be argued that people with lower levels of health have this problem cause by lack of nutrition and not the other way around. I do agree that the healthiest foods and the more expensive variety. Congress subsidizes things like soy and corn, not green beans and broccoli.

So what’s a student to do to stay healthy? After all poor nutrition leads to poor outcomes. One thing I couldn’t stand were the colds I would get while in college. I’m sure stress had something to do with that too.

If a student has a fridge and can cook their own meals, then they should store some good food and cook their own meals. Frozen veggies and fruits store longer than fresh and are better than canned. Canned is better than nothing, but fresh and frozen is best. They take little to heat up in a pan and with some chicken and seasoning make for a quick and healthier option than pizza.

Veggies, fresh or frozen, are a must have for college students.

Veggies, fresh or frozen, are a must have for college students.

Fruit is good too, but can be pricey. If you can get a bargain on some apples, get some. If not, be careful with how much fruit you buy. While healthy, it’s not the biggest bang for your buck.

Rice is a good source of carbs since you can store it almost indefinitely and a little goes a long way. It does require a little time, but if you get a cheap rice cooker, you can cook rice, and a few minutes before it’s done, throw in the frozen veggies to have ready for when the rice is done. Saves time and is inexpensive. Plus you can make double or triple and save some for lunch the next day.

Chicken can usually be found for reasonable prices, especially if you’re willing to deal with bone in. It makes for a good protein. Tuna is another one, in the can of course ( don’t get it with the oil though). If you can’t stand either, ground beef might be a likelier option, though you’ll have to do some shopping to find a good price, or just find it on sale.

For those that go to the cafeteria, it’s a little different picture. The cafeteria is great if you have a food plan because it’s saves the time of cooking and clean up. It’s the options presented that can be problematic.

Pizza, as mentioned earlier, is full of a lot of empty calories. I’m not saying don’t ever eat it, just make sure it’s once in a while rather than 3-4 times per week. Load up on veggies along with whatever protein source you can. You’ll feel full longer than if you load up on carbs. Fruit once or twice a day is good too during lunch or dinner at the cafeteria. Sometimes it can add up though, depending on how the cafeteria is run. .

Stick to regular milk rather than chocolate milk. Again that’s most of the time. One time a week of chocolate milk won’t hurt, but every single day is a lot of extra sugar. Water should be a staple. Get a good water bottle and keep it filled up. There’s no need to buy water all the time, especially when it’s free.

Cherry pie will make you happy. GUARANTEED! Although it will be shortlived. So only indulge once in a while. So make it a real treat and not a waistline gainer.

Cherry pie will make you happy. GUARANTEED! Although it will be shortlived. So only indulge once in a while. So make it a real treat and not a waistline gainer.

Excess sugar can cause things like increase weight and problems with stress. Dessert should be an ocassional treat, not a daily event. I know it’s hard at times because sweets relieve stress, at least temporarily, but they add up to a ticking time bomb if not kept in check. Exercise, emotional support, mediation, church groups, or maybe a weekend of Star Wars is a much better coping mechanism to stress than dessert.

Alcohol is another leacher of nutrition, specifically B vitamins. I recommend not drinking at all. If it is a must, benders, keggers, 21 runs, and frat parties should be avoided. They do nothing to further academic achievement and void your body of essential things it needs to help you in studying. I remember a few times in the anatomy lab trying to help students that had horrible headaches from the previous night’s parties. They had a spectacularly difficult time in anatomy.

If it’s in the budget, a multivitamin is probably a good call. It can help fill in some of the gaps. If not, stick to the veggies.

In short, tupperware and a little thinking ahead (look at the paragraph about rice) can keep a college student fed and with some nutritious foods as well. I personally believe that if we actually taught people health and then made them accountable for it, many health problems in this country would soon disappear. I’m talking actually teaching nutrition and not just show teenagers slides of STD’s in “health” class.

In the end your health, and your nutrition status is your responsiblity. Learn about it and learn what you can do to better it.

CIAO

 

1.Hughes R, Serebryanikova I, Donaldson K, Leveritt M. Student food insecurity: The skeleton in the university closet. Nutrition & Dietetics. 2011;68(1):27-32

2.Chaparro MP, Zaghloul SS, Holck P, Dobbs J. Food insecurity prevalence among college students at the University of Hawaiʻi at Manoa. Public Health Nutrition.
2009;12(11):2097-2103

3.Prevalence and Correlates of Food Insecurity Among Students Attending a Midsize Rural University in Oregon Patton-López, Megan M. et al. Journal of Nutrition Education and Behavior , Volume 46 , Issue 3 , 209 – 214

Can I Trust What I Read Online About Health?

Many times I’ve searched high and low for information in the one area where information exists as it has during no other time in human history; the internet. And the internet is a big freaking place.

Falling asleep at the library trying to find information about your health concern? No longer! You have the internet.

Falling asleep at the library trying to find information about your health concern? No longer! You have the internet.

You can find whatever you want. Movies, books, facts, lies, porn, recipes, and of course cat videos. It’s literally all there.

Health facts, diagnoses, treatments, opinions, studies, and yes, blogs (just like this one) are present as well. Many sciences are present on the web. Bill Nye and Neil deGrasse Tyson are personalities that bring science to many a person and make it interesting to learn.

Many people want to believe what they learn online about many different things. After all, if you have a question, it’s ridiculously easy to “research” it online and get an answer. You can even go to places like ask.com and ask questions and have people weigh in.

Questions are the beginning of knowledge. The problem is the knowledge is only good if the answer is truth. If it isn’t truth, even if it is meant with the best of intentions, doesn’t confer any knowledge at all that will be beneficial. Sometimes you get two or more answers that are equally beneficial. Sometimes there are just no good answers.

For example: lets say I make a Google query about how to clean a microwave. One website says fill a microwave safe bowl with water and put it in the microwave for a few minutes and let the steam clean it. Wipe up and be done. Another says that you have to mix vinegar and water for the effect. Both work, at least in my experience.

Another example might be pseudoephedrine side effects. Say you’re taking some because you are congested. Maybe the pharmacist told you that it might give you insomnia, which is true, it might. Before you take one though, you decide your pharmacist is an untrustworthy idiot (some may be) and so you do some of your own research online and find that pseudoephedrine can cause drowsiness, just the opposite of what the pharmacist said. “That dummy shouldn’t be practicing” is what you’re thinking now and you take some before bed.

What happens? For some, nothing. For some, they sleep better. For others, the have insomnia. For the insomniacs and the people who had nothing happen, they’ll be more likely to believe the pharmacist, and now trust him/her a little more the next time counsel is given. For the others who sleep a little harder, they’ll think that the internet was right and the pharmacist is a dolt. Next time they visit they pharmacy, they won’t trust, or even ask because they can probably do the fact gathering online.

Some people can't sleep at night if they take the wrong drug, even if the pharmacist told them it would

Some people can’t sleep at night if they take the wrong drug, even if the pharmacist told them it would

Another issue that arises is that of bias toward a theory. It’s called confirmation bias. In other words, you seek out information which supports what you believe is true and disregard other data because you don’t agree with the results. On things like recipes, adding cilantro rather than basil might not have serious implications to health policy at large. But if you’re looking at the food recommendations by the government (which just changed by the way) and you agree with them, you can rest easy knowing that your knowledge is sound.

But if you disagree with the food recommendations by the government because you’ve done research and generally think that the whole system is run by idiots, then when anything comes up about the food pyramid or MyPlate, you’ll roll your eyes into the back of your head, facepalm, and switch to another website that supports your dietary view.

Another hot topic these days is vaccinations. If your pro-vaccine, you’ll look at stories and research that is pro-vaccine. If you’re anti-vaccine, you’ll do the same but for anti-vaccine information.

Some people will judge information by the level of sophistication of the “look” of a website. If it looks credible, then it must be. Others will look to see if it’s written by a doctor. If it’s just some blogger then it must be wrong or misguided. The opposite is also true. If it’s written by a doctor, then some will think they are in the pocket of big pharma and only have a vested financial interest to what they write.

So how do you sort through everything?

For starters, it’s not a bad thing to take everything on the internet with a little skepticism. If a claim about natural cancer treatment is available and has unbelievable results, that’s all fine and well, but I need to do some research before it does. I typically ask myself these questions:

Are there studies to back up the results?

Is it a news report that gives generalities or does it give actual explanations? (you have to be careful with these because I’ve seen that new articles can really magnify something that isn’t so big or misquote things that have been said)

Does it give references that I can look up myself to verify what has been written or blogged about?

Does it makes sense? (Sometimes breakthroughs don’t intuitively makes sense, but if the explanation is causing your brain to shut down from over thinking, it is probably a red flag)

Do some homework and think about what it is you read before you make a decision. You have gray matter in your head to think, so think.

Another thing to look for is does what you’re reading about make blanket statements such as “Reduce blood pressure guaranteed” or “Never have another headache again” or “Get rid of arthritis for good”. Others might include “Drug X has no safety problems” or “Drug Y doesn’t cause cancer” or “Cherry Pie doesn’t bring happiness”. Did you notice that last one? That one iscompletely false and shouldn’t ever be a headline. Blanket statements should be a red flag. (Yes I’m aware I just made a blanket statement about cherry pie)

Cherry pie will make you happy. GUARANTEED! This is a blanket statement that should make you think twice about its validity, although cherry pie brings me joy every time.

Cherry pie will make you happy. GUARANTEED! This is a blanket statement that should make you think twice about its validity, although cherry pie brings me joy every time.

As a side note, I try not to make blanket statements, but I probably have. Take those with caution and do some research.

The fitness industry is filled with this kind of crap. “Lose 10lbs in a week” and other such catchy phrases sell billions in the United States alone. Steroid laden models mislead many males about how beneficial testosterone boosters can be. Can acai berries really make you look 20 years younger? Probably, if you live right, reduce stress, drink lots of water, find balance and maybe eat some acai berries. But if you just eat acai berries, probably not.

Lastly I want to return to my first example of pseudoephedrine. In lots of research, especially with physics and chemistry, we can reduce down the number of confounders and variables to get good results. Online we can’t do that so well, especially with treatments such as onion juice for hair growth. Hey, maybe it works wonders for some, but for others it leaves them smelling like onions. I hope they use walla walla sweets.

But that’s my point; with health some things actually do work for some people and for others they don’t. Simvastatin doesn’t prevent 100% of heart attacks or death in people who take it to reduce cholesterol. It reduces the absolute risk by a couple of percentage points, depending on the study. So for a few it will prevent heart attacks, but for the large majority, it won’t. We can argue about the value of that in another post, but it still doesn’t change that it doesn’t work for everyone.

So when looking online for information, take the time to actually research and think about what it is you’re looking at. If putting onion juice on your head for hair growth sounds like it might be a good idea, then go for it and let me know how it works because I have a receding hair-line. Will it harm you? Does it makes sense? Is it backed by anything?

This is my first post in a while that has no references. Does that raise a red flag? Maybe, maybe not. This is my opinion post afterall. So maybe you need to think about it. I hope you will apply some of the principles to everything you read online, not just health.

CIAO