Whey Protein (Ma’aljobon) as a Complementary Therapy for Treatment of Attention-deficit/ Hyperactivity Disorder (ADHD): A Randomized Open-label Controlled Clinical Trial
DOI:
https://doi.org/10.31661/gmj.v9i.1690Keywords:
Attention Deficit Disorder with Hyperactivity; Whey Proteins; Complementary Therapies; Integrative Medicine; Traditional Persian MedicineAbstract
Background: Attention deficit hyperactivity disorder (ADHD) is a common, chronic, neurodevelopmental disorder that manifests in childhood with symptoms of hyperactivity, inattention, and impulsivity. Ma’aljobon (a kind of whey protein) that is derived from milk during cheese producing process is a popular dietary traditional product supposed to provide immune modulation and prevent neuropsychiatric disorder. We aimed to evaluate the efficacy of ma’aljobon in management of Attention-deficit/hyperactivity disorder (ADHD). Materials and Methods: In this open-label randomized, double arm, and controlled clinical trial, sixty four patients with ADHD who referred to out-patient child and adolescent clinic of Khorshid Hospital of Isfahan, Iran, were randomly assigned in the intervention group (ma’aljobon 25 g once daily plus standard conventional treatment (SCT)) or control group (SCT only) for a period of 8 weeks. Scores of the Strengths and Difficulties Questionnaire (SDQ) and Conners’ Continuous Performance Test (CPT) were set as the outcome measures. Results: Parent reported hyperactivity scale of SDQ showed a significant decrease in the intervention group compared to the control group (P=0.04). However, no significant between groups differences were observed in other scales of parent-reported SDQ. Also, according to the results of CPT, there was a significant improvement in the intervention group regarding attention and focus score (P=0.01). Conclusion: Ma’aljobon might be considered as a complementary remedy for improving hyperactivity, attention and focus of children with ADHD. However, further researches with larger sample size and longer duration should be done for achieving more reliable results. [GMJ.2020;9:e1690]
References
Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics. 2012; 9(3): 490-499. https://doi.org/10.1007/s13311-012-0135-8PMid:22976615 PMCid:PMC3441936 Ghanizadeh A. Psychiatric comorbidity differences in clinic-referred children and adolescents withADHD according to the subtypes and gender. J Child Neurol. 2009; 24(6): 679-684. https://doi.org/10.1177/0883073808331086PMid:19491114 Noorbala A-A, Akhondzadeh S. Attention-deficit/hyperactivity disorder: etiology andpharmacotherapy. Arch Iran Med. 2006; 9(4): 374-380. Amiri S, Mohammadi M-R, Mohammadi M, Nouroozinejad G-H, Kahbazi M, Akhondzadeh S. Modafinil as a treatment for Attention-Deficit/Hyperactivity Disorder in children and adolescents: adouble blind, randomized clinical trial. Prog Neuro-Psychoph. 2008; 32(1): 145-149. https://doi.org/10.1016/j.pnpbp.2007.07.025PMid:17765380 Mohagheghi A, Amiri S, Moghaddasi Bonab N, Chalabianloo G, Noorazar SG, Tabatabaei SM, Farhang S. A randomized trial of comparing the efficacy of two neurofeedback protocols for treatment of clinical and cognitive symptoms of ADHD: theta suppression/beta enhancement and theta suppression/alphaenhancement. Biomed Res Int. 2017; 2017. https://doi.org/10.1155/2017/3513281PMid:28321406 PMCid:PMC5340952 Ng QX, Ho CYX, Chan HW, Yong BZJ, Yeo WS. Managing childhood and adolescent attention- deficit/hyperactivity disorder (ADHD) with exercise: A systematic review. Complement Ther Med. 2017; 34: 123-128. https://doi.org/10.1016/j.ctim.2017.08.018PMid:28917364 Pellow J, Solomon EM, Barnard CN. Complementary and alternative medical therapies for children with attention-deficit/hyperactivity disorder (ADHD). Altern Med Rev. 2011; 16(4): 323. Arnold LE. 78.1 Complementary and Integrative Medicine in Attention-Deficit/Hyperactivity Disorder.J Am Acad Child Psy. 2017; 56(10): S116. https://doi.org/10.1016/j.jaac.2017.07.456 Dehkordian P, Hamid N, Beshlideh K. The effectiveness of mindful parenting, social thinking andexercise on quality of life in ADHD children. Int J Pediatr Obes. 2017; 5(2): 4295-4302. Anheyer D, Lauche R, Schumann D, Dobos G, Cramer H. Herbal medicines in children with attention deficit hyperactivity disorder (ADHD): A systematic review. Complement Ther Med. 2017;30: 14-23. https://doi.org/10.1016/j.ctim.2016.11.004PMid:28137522 Sarris J, Kean J, Schweitzer I, Lake J. Complementary medicines (herbal and nutritional products) in the treatment of Attention Deficit Hyperactivity Disorder (ADHD): a systematic review of the evidence.Complement Ther Med. 2011; 19(4): 216-227. https://doi.org/10.1016/j.ctim.2011.06.007PMid:21827936 Navabzadeh M, Hashem-Dabaghian F, Shojaii A, Kazemi T, Hadinia J, Ghods T, Ghods R. The effect of a kind of whey protein (Ma'oljobon) on Insomnia: A randomized clinical trial. Complement Ther Clin Pract. 2019; 34: 275-279. https://doi.org/10.1016/j.ctcp.2019.01.001PMid:30712738 Kume H, Okazaki K, Takahashi T, Yamaji T. Protective effect of an immune-modulating diet comprising whey peptides and fermented milk products on indomethacin-induced small-boweldisorders in rats. Clin Nutr (Edinburgh, Scotland). 2014; 33(6): 1140-1146. https://doi.org/10.1016/j.clnu.2013.12.014PMid:24461940 Nakamura K, Ogawa S, Dairiki K, Fukatsu K, Sasaki H, Kaneko T, Yamaji T. A new immune-modulating diet enriched with whey-hydrolyzed peptide, fermented milk, and isomaltulose attenuates gut ischemia-reperfusion injury in mice. Clin Nutr (Edinburgh, Scotland). 2011; 30(4): 513-516. https://doi.org/10.1016/j.clnu.2011.01.002PMid:21281994 Kume H, Okazaki K, Yamaji T, Sasaki H. A newly designed enteral formula containing whey peptides and fermented milk product protects mice against concanavalin A-induced hepatitis by suppressingoverproduction of inflammatory cytokines. Clin Nutr (Edinburgh, Scotland). 2012; 31(2): 283-289. https://doi.org/10.1016/j.clnu.2011.10.012PMid:22119211 Bell SJ, Forse RA, Bistrian BR, Jones RC. Nutritional supplement for use in the treatment of attention deficit. 1999. Keri Marshall N. Therapeutic applications of whey protein. Altern Med Rev. 2004; 9(2): 136-156. Ignowski E, Winter AN, Duval N, Fleming H, Wallace T, Manning E, Koza L, Huber K, Serkova NJ, Linseman DA. The cysteine-rich whey protein supplement, Immunocal®, preserves brain glutathione and improves cognitive, motor, and histopathological indices of traumatic brain injury in a mouse model of controlled cortical impact. Free Radical Bio Med. 2018; 124: 328-341. https://doi.org/10.1016/j.freeradbiomed.2018.06.026PMid:29940352 PMCid:PMC6211803 Garg G, Singh S, Singh AK, Rizvi SI. Whey protein concentrate supplementation protects rat brain against aging-induced oxidative stress and neurodegeneration. Appl Physiol Nutr Med. 2017; 43(5): 437-444. https://doi.org/10.1139/apnm-2017-0578PMid:29199432 Madureira AR, Pereira CI, Gomes AM, Pintado ME, Malcata FX. Bovine whey proteins-overview ontheir main biological properties. Food Res Int. 2007; 40(10): 1197-1211. https://doi.org/10.1016/j.foodres.2007.07.005PMCid:PMC7126817 Smithers GW. Whey and whey proteins-from 'gutter-to-gold'. Int Dairy J. 2008; 18(7): 695-704. https://doi.org/10.1016/j.idairyj.2008.03.008 Markus CR, Olivier B, Panhuysen GE, Van der Gugten J, Alles MS, Tuiten A, Westenberg HG, Fekkes D, Koppeschaar HF, de Haan EE. The bovine protein α-lactalbumin increases the plasma ratio of tryptophan to the other large neutral amino acids, and in vulnerable subjects raises brain serotoninactivity, reduces cortisol concentration, and improves mood under stress. Am J Clin Nutr.2000; 71(6): 1536-1544. https://doi.org/10.1093/ajcn/71.6.1536PMid:10837296 Markus CR, Olivier B, de Haan EH. Whey protein rich in α-lactalbumin increases the ratio of plasma tryptophan to the sum of the other large neutral amino acids and improves cognitive performance instress-vulnerable subjects. Am J Clin Nutr. 2002; 75(6): 1051-1056. https://doi.org/10.1093/ajcn/75.6.1051PMid:12036812 Tehranidoust M, Shahrivar Z, Pakbaz B, Rezaei A, Ahmadi F. Validity of Farsi Version of Strengths and Difficulties Questionnaire (SDQ). J Adv Cogn Sci. 2007;8(4):33-9. Hadianfard H., Najarian B., Shokrkon H., Mehrabizadeh Honarmand M. Construction and Validation of the Farsi Version of the Continuous Performance Test. J Psychol.2001,4(16),388-404. Akhondzadeh S, Mohammadi M, Momeni F. Passiflora incarnata in the treatment of attention deficit hyperactivity disorder in children and adolescents. Clin Prac. 2005; 2(4): 609. https://doi.org/10.2217/14750708.2.4.609 Gromball J, Beschorner F, Wantzen C, Paulsen U, Burkart M. Hyperactivity, concentration difficulties and impulsiveness improve during seven weeks' treatment with valerian root and lemon balm extracts in primary school children. Phytomedicine. 2014; 21(8-9): 1098-1103. https://doi.org/10.1016/j.phymed.2014.04.004PMid:24837472 Villar-GarcÃa J, Hernández JJ, Güerri-Fernández R, González A, Lerma E, Guelar A, Saenz D, Sorlà L, Montero M, Horcajada JP. Effect of probiotics (Saccharomyces boulardii) on microbial translocation and inflammation in HIV-treated patients: a double-blind, randomized, placebo-controlled trial. J Aids-J Acq Imm Def.2015; 68(3): 256-263. https://doi.org/10.1097/QAI.0000000000000468PMid:25469528 Kaur IP, Kuhad A, Garg A, Chopra K. Probiotics: delineation of prophylactic and therapeutic benefits. J Med Food. 2009; 12(2): 219-235. https://doi.org/10.1089/jmf.2007.0544PMid:19459724 Hirayama K, Rafter J. The role of probiotic bacteria in cancer prevention. Microbes Infect. 2000; 2(6): 681-686. https://doi.org/10.1016/S1286-4579(00)00357-9 El-Nezami HS, Polychronaki NN, Ma J, Zhu H, Ling W, Salminen EK, Juvonen RO, Salminen SJ, Poussa T, Mykkänen HM. Probiotic supplementation reduces a biomarker for increased risk of liver cancer in young men from Southern China-. Am J Clin Nutr. 2006; 83(5): 1199-1203. https://doi.org/10.1093/ajcn/83.5.1199PMid:16685066 Li Z, Yang S, Lin H, Huang J, Watkins PA, Moser AB, DeSimone C, Song Xy, Diehl AM. Probiotics and antibodies to TNF inhibit inflammatory activity and improve nonalcoholic fatty liver disease. Hepaatology. 2003; 37(2): 343-350. https://doi.org/10.1053/jhep.2003.50048PMid:12540784 Nabavi S, Rafraf M, Somi M, Homayouni-Rad A, Asghari-Jafarabadi M. Effects of probiotic yogurt consumption on metabolic factors in individuals with nonalcoholic fatty liver disease. J Dairy Sci. 2014; 97(12): 7386-7393. https://doi.org/10.3168/jds.2014-8500PMid:25306266 Ebel B, Lemetais G, Beney L, Cachon R, Sokol H, Langella P, Gervais P. Impact of probiotics on risk factors for cardiovascular diseases. A review. Crc Cr Rev Food Sci. 2014; 54(2): 175-189. https://doi.org/10.1080/10408398.2011.579361PMid:24188267 Bounous G, Gold P, Kongshavn PA. Biologically active whey protein concentrate. 1994. Gold P. The influence of dietary whey protein on tissue glutathione and the diseases of aging. Clin Invest Med. 1989; 12(6): 343-349.
