Nutrition and ADHD
ADHD is a common clinical diagnosis in children, with peak diagnosis between 8 and 10 years old. In fact, three of the drugs used to treat ADHD (Concerta, Strattera, an Adderall) are among the top five (ranked by spending) prescribed to children in the U.S.1 pg 43. Boys are three times more likely to be diagnosed than girls. ADHD is not an acute diagnosis, but rather a chronic one, which requires ongoing management for the child to function optimally in both school, social, and home settings. The drugs used to treat ADHD often have unwanted side effects such as decreased appetite, insomnia/thrashing in sleep, stomachaches, headaches, anxiety, depression, delayed growth, rebound (irritability when mediation wears off), and tics. These side effects can often lead to more problems than ADHD symptoms do, and many parents look for an alternate route to assist their child in learning to manage their ADHD
In addition to exercise, particularly cross-midline exercises that build balance and coordination, nutrition can be a safe way to manage some of the symptoms seen in children with ADHD. Although the brain is less than 5% of the body’s weight, it uses 20% of the body’s energy supply, which means it needs a constant supply of beneficial vitamins, minerals, amino acids, and energy sources. In an ideal world, these would come directly from diet, but for those who do not eat a well rounded diet, supplements can be useful.
Magnesium supplements are particularly helpful in children with ADHD that are excitable, easily stressed, or worriers (1 pg 46). These symptoms of ADHD can be directly related to both quality and quantity of sleep. Many children with ADHD may sleep 9-12 hours per night, but the quality of sleep may be very poor, never allowing the child to enter full sleep cycles. Their circadian rhythm is then disrupted, leading to agitation. Magnesium allows for more restful sleep by causing relaxation of the skeletal muscles, as well as regulating cortisol, supporting the thyroid (which is responsible or a variety of hormonal pathways), and activating Vitamin D. Many children with ADHD also suffer from constipation, and magnesium brings water into the bowels, allowing for smoother bowel movements.
ADHD is an inflammatory condition; it has recently been shown that Vitamin D aids in activating the anti-inflammatory pathways within our body, while inhibiting pro-inflammatory cells (2). Raising Vitamin D3 to a serum level of 80-90 is desirable. Reaching and maintaining this level is fairly easy to do with time spent outside in the sun, and a daily Vitamin D3 supplement.
Iron deficiency can interfere with memory, concentration, behavior, and both physical and mental performance (1 pg 46). Cooking with cast iron, and using a Lucky Iron Fish, are great ways to add iron to the diet without risking constipation issues by over supplementing. Making sure your child is consuming enough B12 in order to absorb the iron they’re taking in is also essential.
B vitamins are essential cofactors in the production of neurotransmitters, such as serotonin, dopamine, and norepinephrine. A lack of these neurotransmitters can equate to depression, anxiety, restless sleep, and general agitation. B vitamins come in various forms as supplements. The active form used in the body is the methylated form, particularly regarding B12 and Folate. If a nonmethylated variation is taken in, such as cyanocobalamin or folic acid, the body must methylate it prior to being able to use it in a number of pathways, particularly those involving detoxification. MTHFR mutations lead to an inability to properly methylate B vitamins, leading to a buildup of homocysteine and leading to inflammation. It has recently been shown that there is likely a relationship between MTHFR polymorphisms, particularly the A198C mutation, and ADHD3. When supplementing with B vitamins, its important to consider using only methylated forms.
Omega-3 Fatty Acids
Low levels of omega-3 fatty acids have been linked to ADHD and behavioral problems in both children and adults1 pg45. Supplementing with fish oil can raise levels of EPA and DHA, and decrease depression, anxiety, impulsivity, and aggression. Although flax seeds, walnuts, and leafy greens contain linolenic acids, the body only converts about 5-10% of linolenic acid consumed into the useful forms of EPA and DHA1 pg45-46. Eating wild caught sardines, salmon, or mackerel twice weekly, or taking a supplement daily are the best ways to reach adequate levels of Omega-3 fatty acids.
Sugar has been shown over and over to not be related to chronic hyperactivity (1). However, eating simple sugars does cause blood sugar swings which can impair mental and emotional stability. In addition, sugary processed foods often contain artificial colors, flavors, and preservatives.
Artificial Colors, Flavors, and Preservatives
Artificial food colors significantly worsen hyperactivity for many people (1 pg 46). The CSPI (Center for Science in the Public Interest) has asked the FDA to ban the use of dyes linked to hyperactivity, including Blues 1 & 2, Green 3, Orange 8, Reds 3 and 40, Yellows 5 and 6. In studies involving over 1800 children with ADHD, significant improvement in hyperactivity was shown when the flowing were removed from their diets1:
Benzoate Preservatives (BHA, BHT, and TBHQ -also known carcinogens)
Artificial Colors (petroleum based D&C and D&C colors, and caramel coloring)
Fruit and vegetable food colorings are a much safer option when serving children. They can be found in health food store brands of gummy snacks and candy for the occasional treat at a child’s birthday or school party, so they don’t feel left out.
An estimated 10% of children have allergies or sensitivities to foods. Continually consuming a food the body is sensitive to will create inflammation. The most common sensitivities are wheat, corn, soy, dairy, eggs, tree nuts, shellfish, citrus, and peanuts, although this is by no means a complete list. An IgE allergy test can find a histamine based allergic reaction, but not a neutrophilic or IgG mediated reaction. Neutrophlic and IgG mediated reactions are more likely to cause long-term effects associated with ADHD. These can be tested with food sensitivity tests such as the ALCAT or MRT, or found by keeping a correlating food and symptom diary. Eliminating foods that cause an increase in symptoms can often alleviate depression, hyperactivity, lack of concentration, and aggression in children with ADHD.
Organic vs. Conventional
There has been little evidence to show that organically grown produce contains higher levels of vitamins and minerals than conventionally grown. However, pesticides and agrochemical residues are pro-inflammatory and when consumed, activate inflammatory pathways in the body. Children who eat an organic diet have lower levels of these toxins than do children who eat conventionally grown produce. Eating 100% organic is not always a financially feasible option, but shopping or produce according to the Dirty Dozen and Clean Fifteen list can drastically reduce the amount of pesticides consumed.
Other Herbs & Supplements
Caffeine is a natural stimulant that can help alleviate symptoms of ADHD. It is also an addictive drug, and should be used with caution. A small cup of green tea in the morning may be helpful for children with ADHD who have trouble controlling impulses while at school. Green tea also contains theanine, which can be calming. Supplements combinations, such as CentraFx or RelaxMax, containing magnesium, myo-inositol, taurine, GABA, and L-theanine have been shown to alleviate symptoms such as restlessness, hyperactivity, lack of impulse control, anxiety, depression, and aggression. This particular combination of supplements helps to reduce the amount of excitatory neurons being produced, and increase the amount of inhibitory neurons, bringing the ADHD brain back into a more balanced state.
In addition to nutrition and exercise, adjuncts such as behavioral therapy, mindful meditation, chiropractic work, massage, acupuncture, and sending time outdoors can help offer relief from symptoms of ADHD. A wonderful book on parenting a child with ADHD is ADHD Alternatives by Aviva Romm, an herbalist and MD who takes natural approaches to illness and behavior disorders.
Jade Arellano is a clinical nutritionist, wife, and mother of two in Norman, Oklahoma. She owns Balance Holistic Nutrition, where she specializes in healing inflammatory disease through dietary, supplemental, botanical, and environmental modifications. For more information on managing ADHD through diet, she can be reached at firstname.lastname@example.org.
Integrative Medicine. Rakel, David. 2012. Ps 43-53.
Vitamin D and inflammatory diseases. Kai Yin and Devendra K Agrawal. J Inflamm Res. 2014; 7: 69–87. Published online 2014 May 29. doi: 10.2147/JIR.S63898. Accessed 3/24/17. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4070857/.
Methylenetetrahydrofolate Reductase Gene Polymorphisms in Children with Attention Deficit Hyperactivity Disorder. Cem Gokcen, Nadir Kocak, and Ahmet Pekgor. Int J Med Sci. 2011; 8(7): 523–528. Published online 2011 Aug 30. Accessed 3/24/17. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3167178/.