Case Study Except: A Holistic Approach to ADHD

Patient Information

Maeve is a 25-year-old woman working in urban design in New York City as a research associate. She has a hybrid work schedule and she’s in the office three days a week. Maeve is active, running three to four miles five days a week. She usually eats yogurt with granola and fruit for breakfast, mostly frozen meals for dinner, and will usually skip lunch, having multiple snacks like toast and cheese and crackers throughout the day. She has trouble focusing but does not like taking her ADHD medicine as it makes her feel irritable, anxious, and overly serious.    

• Name: Maeve
• Race/Ethnicity: Caucasian, Non-Hispanic
• Date of Birth: May 4, 1996
• Marital Status: Single
• Health Concerns: Attention-deficit/hyperactivity disorder (ADHD), Anxiety/Depression
• Allergies: None

Social History:

• Alcohol: Occasionally drinks one beer on weekdays, heavier drinker on weekends (3+ drinks)
• Smoking: No history

Vital signs:

• Height: 65 inches (5’5”)
• Weight: 130 pounds
• BMI: 21.6
• Total Cholesterol: 130 mg/dL
• HDL Cholesterol: 65 mg.dL
• LDL Cholesterol: 96 mg/dL
• Blood pressure systolic: 118 mmHg
• Blood pressure diastolic: 78 mmHg
• Non-fasting glucose: 99 mg/dL

Medications:

• Lisdexamfetamine

Practitioner Perspective: Peter Bongiorno, ND, LAC

As a naturopathic physician, Peter believes Maeve would benefit from a holistic treatment approach for her ADHD. Since Maeve was previously overwhelmed by her ADHD medication, Peter would address her symptoms of inattentiveness and anxiety with a combination of supplements as well as lifestyle, and dietary changes with a goal of reducing or eliminating her need for a stimulant.

First Visit

Peter’s first visit with Maeve would last around 80 minutes. During that session, they would sit down and get to know each other. He would ask her about things like hobbies, her career, likes and dislikes, and family. After getting to know Maeve on a more personal level, Peter would ask Maeve “if I could wave a magic wand, what would you like to be better or more balanced in your life as far as medical and health issues are concerned?” This would give Maeve the opportunity to tell Peter what’s bothering her and what she would like to see fixed.

After getting an understanding of her chief complaints, Peter would dive into questions about Maeve’s diet, exercise, lifestyle, and daily schedule, as well as her preferences for those factors. This would give Peter a sense of what kind of change would work best for her.

Care Plan

Concerning Maeve’s care plan, Peter would first address her sleeping habits. Since Maeve is often staying up late and having difficulty falling asleep, Peter may suggest she try melatonin. Melatonin has been shown to be helpful for children with delayed sleep onset who also have ADHD. In addition, it can be helpful for adults who want to reset their circadian rhythms. Peter would also make sure Maeve is sleeping in a dark room and limiting screen time before bed. Reducing screen time and T.V. can be challenging, especially in a patient with ADHD. This is something that Peter and Maeve would work on together, coming up with strategies that would help her avoid electronics.

As for Maeve’s diet, Peter would suggest that she eat more protein. Maeve’s daily breakfast of yogurt, granola, and fruit does not provide her with enough protein to begin her morning, he said. In addition, having only carbfilled snacks in the afternoon is not providing Maeve with enough subsistence to maintain focus throughout the day. Protein and amino acids are the building blocks for dopamine and norepinephrine, neurotransmitters essential for focus, Peter said. Making sure Maeve is getting those building blocks throughout the day would be a priority.

In addition, eating nutritious, regularly timed meals throughout the day, provides for a much more balanced blood sugar, which is helpful for brain function. Peter would also encourage Maeve to continue to exercise, as it raises dopamine and norepinephrine.

Since Maeve experienced symptoms of anxiety, irritability, and lack of appetite on her ADHD medication, Peter said he would introduce her to a more natural approach to ADHD treatment. Peter would explain that a natural approach can be gentler and more balanced than conventional treatments for ADHD. Changing Maeve’s diet and managing her blood sugar is a start, but Peter would also suggest using supplements. He may recommend Bacopa, which is a neuroprotective herbal medication that can help with learning tasks and memory. In addition, Peter may suggest she try taking fish oil supplements, which can help with ADHD.

Low levels of iron, zinc, and other trace minerals can cause people to be more inattentive and distractable, so Peter may run lab tests on Maeve and suggest iron and zinc supplements depending on her results. While supplements alone would not cure her ADHD symptoms, using them in conjunction with a good sleep regimen, healthy eating, regularly scheduled mealtimes, and exercise, could make a significant difference for patients like Maeve, who struggle to stay centered and focused.

After addressing lifestyle and nutrition for her ADHD symptoms, Peter would assess Maeve’s anxiety levels. If her anxiety was secondary, once her ADHD symptoms were under control her anxiety should be as well. If her anxiety was more primary, Peter would consider some holistic ways to calm Maeve’s anxiety such as mindfulness techniques, natural ways to stimulate the vagus nerve, and certain minerals, like nutritional lithium, and/or cannabidiol, which can help calm the endocannabinoid system.

Case Considerations

Before designing his care plan, Peter would find out what Maeve's preferences are in terms of diet and lifestyle to better understand what she is willing to change and what her schedule would allow for. Peter would explain that he would cater her treatment plan to whatever pace she was comfortable with. In addition, he would create a trusting relationship between him and Maeve, which is the foundation for patient compliance.

Long-Term

Peter’s long-term plan for Maeve would be to successfully make lifestyle and diet changes, use supplements to renourish her brain, and possibly have her take an herb like Bacopa to provide additional neuroprotection and support for brain stimulation. Peter’s goals for Maeve would be to see improvements in how she’s feeling and, hopefully, reduce or eliminate her need for ADHD medication.

About the Expert

Peter Bongiorno, ND, LaC, has been in practice since 2003 with thriving practices in both New York City and Long Island, New York focused on natural medicine for mental health problems. He also works with many clients from around the world via telehealth.  In the early and mid-1990s Peter was a research assistant first at Yale School of Medicine, and then at the NIH’s National Institutes of Mental Health’s department of Clinical Neuroendocrinology before training at Bastyr University in naturopathic medicine and acupuncture. He is past president of the NY Association of Naturopathic Physicians and has been active in working towards gaining naturopathic licensing in New York. A major contributing author to the “Textbook of Natural Medicine” (Elsevier), Bongiorno’s own books, “Healing Depression,” “How Come They’re Happy and I’m Not,” and “Put Anxiety Behind You: The Complete Drug Free Program,” focus on using natural medicines for mental healthcare. Peter is also a sought-after lecturer, and he has been a featured speaker at the top integrative medicine conferences, including A4M in Las Vegas, the Integrative Healthcare Symposium in New York, and the Integrative Medicine for Mental Health Conferences.

Editor's note: This article is an excerpt from the e-book, Treating ADHD with Whole Person Care: An Integrative Medicine Case Study. To read more, click here.