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Wednesday, July 22, 2015

Nurture and Clarity for the Treatment of ADHD: Clinically Proven, but Will It Work For You?

Nurture and Clarity is an herbal preparation which may be used in the treatment of ADHD.  The sellers of Nurture and Clarity claim that the preparation is "clinically proven to help people with ADHD", but will it work for you?

How it works
Per the manufacturer's website, Nurture and Clarity is a proprietary mixture of herbs.  In other words, the manufacturer does not really want to release the exact ingredients to the public.  This is understandable, but doesn't do a lot to help us understand how this mixture could be working in the body, or what kinds of reactions it could have with other medications.

 Effectiveness
The manufacturer of Nurture and Clarity has conducted one randomized, blinded, placebo controlled study of 120 children.  The results showed significant improvement in the treatment group of 80 children.  Almost half of the children in the control group dropped out of the study, however.  While the study authors suggested that this is evidence that the placebo was ineffective, most clinical trials demonstrating efficacy do not have such a high drop-out rate, suggesting that this might not be the issue at hand. 

In addition, the study was funded by the manufacturer and two of the study's authors are the founders of the company that makes Nuture and Clarity.  This does not mean that the study is invalid, but it means the results could be biased.

The study used a test called the TOVA (Test of Variables of Attention) to assess the response to treatment.  This test basically measures the performance of the patient in a computerized game.  In one way, it is objective, but the disadvantage is that it does not measure real-life behavioral problems or hyperactivity.  Although the manufacturer claims that other questionnaires measuring day to day behaviors were performed, the results were not published.

Compared to other nonmedicinal strategies, this preparation has only preliminary clinical trial support.  The results need to be replicated in other trials with greater numbers before the claim that this is a "clinically proven" remedy can be substantiated.

Side effects
Unlike some natural supplements for ADHD, the ingredients found in Nurture and Clarity are not found in foods that people normally consume on a daily basis.  So, it is possible that the herbs that make up Nurture and Clarity could have significant side effects.  In the manufacturer's clinical trial, the placebo group showed more side effects than the supplement.  However, the known ingredients in Nurture and Clarity have known side effects and potential for other side effects based on their other therapeutic uses.
For example:
Paeoniae alba can cause stomach upset and rash.  It has the potential to also slow blood clotting and cause uterine cramping, which may make it unsafe during pregnancy.
Withania somnifera can cause stomach upset or diarrhea.  It has the potential to lower blood pressure, blood sugar, and thyroid hormone levels.  It also may cause miscarriages.

The manufacturer's trial also does not address the safety of the preparation over more than 4 months of continous use.  Also, since the preparation was used in children, it is unlikely that drug interactions would have been noted. 

Overall, this preparation is promising, but independent trials are needed to confirm that it is effective.  It also requires more trials to demonstrate its side effects, especially in the long term and in adults.  At this point in time, I would not recommend this as a treatment for most patients with ADHD.  However, for patients who have been unable to tolerate medication or other treatments with more evidence of effectiveness and less potential for side effects (such as neurofeedback or behavioral therapy), this may be an option for an otherwise healthy. nonpregnant patient.







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