Attention deficit hyperactivity disorder (ADHD) is a condition that can affect all stages of life. Medication is not the only treatment, but it is often the treatment that can make the most obvious difference to a person who has difficulties focusing attention, sitting still or not acting on impulse.

But what happens once you’ve found the medication that works for you or your child? Do you just keep taking it forever? Here’s what to consider.

What are ADHD medications?

The mainstay of medication for ADHD is stimulants. These include methylphenidate (with brand names Ritalin, Concerta) and dexamfetamine. There is also lisdexamfetamine (branded Vyvanse), a “prodrug” of dexamfetamine (it has a protein molecule attached, which is removed in the body to release dexamfetamine).

There are also non-stimulants, in particular atomoxetine and guanfacine, which are used less often but can also be highly effective. Non-stimulants can be prescribed by GPs but this may not always be covered by the Pharmaceutical Benefits Scheme and could cost more.

How stimulants work

Some stimulants prescribed for ADHD are “short acting”. This means the effect comes on after around 20 minutes and lasts around four hours.

Longer-acting stimulants give a longer-lasting effect, usually by releasing medication more slowly. The choice between the two will be guided by whether the person wants to take medication once a day or prefers to target the medication effect to specific times or tasks.

For the stimulants (with the possible exception of lisdexamfetamine) there is very little carry-over effect to the next day. This means the symptoms of ADHD may be very obvious until the first dose of the morning takes effect.

One of the main aims of treatment is the person with ADHD should live their best life and achieve their goals. In young children it is the parents who have to consider the risks and benefits on behalf of the child. As children mature, their role in decision making increases.

What about side effects?

The most consistent side effects of the stimulants are they suppress appetite, resulting in weight loss. In children this is associated with temporary slowing of the growth rate and perhaps a slight delay in pubertal development. They can also increase the heart rate and may cause a rise in blood pressure. Stimulants often cause insomnia.

These changes are largely reversible on stopping medication. However, there is concern the small rises in blood pressure could accelerate the rate of heart disease, so people who take medication over a number of years might have heart attacks or strokes slightly sooner than would have happened otherwise.

This does not mean older adults should not have their ADHD treated. Rather, they should be aware of the potential risks so they can make an informed decision. They should also make sure high blood pressure and attacks of chest pain are taken seriously.

Stimulants can be associated with stomach ache or headache. These effects may lessen over time or with a reduction in dose. While there have been reports about stimulants being misused by students, research on the risks of long-term prescription stimulant dependence is lacking.

Will medication be needed long term?

Although ADHD can affect a person’s functioning at all stages of their life, most people stop medication within the first two years.

People may stop taking it because they don’t like the way it makes them feel, or don’t like taking medication at all. Their short period on medication may have helped them develop a better understanding of themselves and how best to manage their ADHD.

In teenagers the medication may lose its effectiveness as they outgrow their dose and so they stop taking it. But this should be differentiated from tolerance, when the dose becomes less effective and there are only temporary improvements with dose increases.

Tolerance may be managed by taking short breaks from medication, switching from one stimulant to another or using a non-stimulant.

Too many prescriptions?

ADHD is becoming increasingly recognised, with more people – 2–5% of adults and 5–10% of children – being diagnosed. In Australia stimulants are highly regulated and mainly prescribed by specialists (paediatricians or psychiatrists), though this differs from state to state. As case loads grow for this lifelong diagnosis, there just aren’t enough specialists to fit everyone in.

In November, a Senate inquiry report into ADHD assessment and support services highlighted the desperation experienced by people seeking treatment.

There have already been changes to the legislation in New South Wales that may lead to more GPs being able to treat ADHD. Further training could help GPs feel more confident to manage ADHD. This could be in a shared-care arrangement or independent management of ADHD by GPs like a model being piloted at Nepean Blue Mountains Local Health District, with GPs training within an ADHD clinic (where I am a specialist clinician).

Not every person with ADHD will need or want to take medication. However, it should be more easily available for those who could find it helpful.

Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

You’ve probably seen recent claims online seed oils are “toxic” and cause inflammation, cancer, diabetes and heart disease. But what does the research say?

Overall, if you’re worried about inflammation, cancer, diabetes and heart disease there are probably more important things to worry about than seed oils.

They may or may not play a role in inflammation (the research picture is mixed). What we do know, however, is that a high-quality diet rich in unprocessed whole foods (fruits, vegetables, nuts, seeds, grains and lean meats) is the number one thing you can to do reduce inflammation and your risk of developing diseases.

Rather than focusing on seed oils specifically, reduce your intake of processed foods more broadly and focus on eating fresh foods. So don’t stress out too much about using a bit of seed oils in your cooking if you are generally focused on all the right things.

What are seed oils?

Seed oils are made from whole seeds, such as sunflower seeds, flax seeds, chia seeds and sesame seeds. These seeds are processed to extract oil.

The most common seed oils found at grocery stores include sesame oil, canola oil, sunflower oil, flaxseed oil, corn oil, grapeseed oil and soybean oil.

Seed oils are generally affordable, easy to find and suitable for many dishes and cuisines as they often have a high smoke point.

However, most people consume seed oils in larger amounts through processed foods such as biscuits, cakes, chips, muesli bars, muffins, dipping sauces, deep-fried foods, salad dressings and margarines.

These processed foods are “discretionary”, meaning they’re OK to have occasionally. But they are not considered necessary for a healthy diet, nor recommended in our national dietary guidelines, the Australian Guide for Healthy Eating.

I’ve heard people say seed oils ‘promote inflammation’. Is that true?

There are two essential types of omega fatty acids: omega-3 and omega-6. These are crucial for bodily functions, and we must get them through our diet since our bodies cannot produce them.

While all oils contain varying levels of fatty acids, some argue an excessive intake of a specific omega-6 fatty acid in seed oils called “linoleic acid” may contribute to inflammation in the body.

There is some evidence linoleic acid can be converted to arachidonic acid in the body and this may play a role in inflammation. However, other research doesn’t support the idea reducing dietary linoleic acid affects the amount of arachidonic acid in your body. The research picture is not clear cut.

But if you’re keen to reduce inflammation, the best thing you can do is aim for a healthy diet that is:

• high in antioxidants (found in fruits and vegetables)
• high in “healthy”, unsaturated fatty acids (found in fatty fish, some nuts and olive oil, for example)

• high in fibre (found in carrots, cauliflower, broccoli and leafy greens) and prebiotics (found in onions, leeks, asparagus, garlic and legumes)

• low in processed foods.

If reducing inflammation is your goal, it’s probably more meaningful to focus on these basics than on occasional use of seed oils.

What about seed oils and heart disease, cancer or diabetes risk?

Some popular arguments against seed oils come from data from single studies on this topic. Often these are observational studies where researchers do not make changes to people’s diet or lifestyle.

To get a clearer picture, we should look at meta-analyses, where scientists combine all the data available on a topic. This helps us get a better overall view of what’s going on.

A 2022 meta-analysis of randomised controlled trials investigated the relationship between supplementation with omega-6 fatty acid (often found in seed oils) and cardiovascular disease risk (meaning disease relating to the heart and blood vessels).

The researchers found omega-6 intake did not affect the risk for cardiovascular disease or death but that further research is needed for firm conclusions. Similar findings were observed in a 2019 review on this topic.

The World Health Organization published a review and meta-analysis in 2022 of observational studies (considered lower quality evidence compared to randomised controlled trials) on this topic.

They looked at omega-6 intake and risk of death, cardiovascular disease, breast cancer, mental health conditions and type 2 diabetes. The findings show both advantages and disadvantages of consuming omega-6.

The findings reported that, overall, higher intakes of omega-6 were associated with a 9% reduced risk of dying (data from nine studies) but a 31% increased risk of postmenopausal breast cancer (data from six studies).

One of the key findings from this review was about the ratio of omega-3 fatty acids to omega-6 fatty acids. A higher omega 6:3 ratio was associated with a greater risk of cognitive decline and ulcerative colitis (an inflammatory bowel condition).

A higher omega 3:6 ratio was linked to a 26% reduced risk of depression. These mixed outcomes may be a cause of confusion among health-conscious consumers about the health impact of seed oils.

Overall, the evidence suggests that a high intake of omega-6 fatty acids from seed oils is unlikely to increase your risk of death and disease.

However, more high-quality intervention research is needed.

The importance of increasing your omega-3 fatty acids

On top of the mixed outcomes, there is clear evidence increasing the intake of omega-3 fatty acids (often found in foods such as fatty fish and walnuts) is beneficial for health.

While some seed oils contain small amounts of omega-3s, they are not typically considered rich sources.

Flaxseed oil is an exception and is one of the few seed oils that is notably high in alpha-linolenic acid (sometimes shortened to ALA), an omega-3 fatty acid.

If you are looking to increase your omega-3 intake, it’s better to focus on other sources such as fatty fish (salmon, mackerel, sardines), chia seeds, hemp seeds, walnuts, and algae-based supplements. These foods are known for their higher omega-3 content compared to seed oils.

The bottom line

At the end of the day, it’s probably OK to include small quantities of seed oils in your diet, as long as you are mostly focused on eating fresh, unprocessed foods.

The best way to reduce your risk of inflammation, heart disease, cancer or diabetes is not to focus so much on seed oils but rather on doing your best to follow the Australian Guide for Healthy Eating.

Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Lecturer, Southern Cross University

This article is republished from The Conversation under a Creative Commons license. Read the original article.