Attention Deficit Hyperactivity Disorder (ADHD) is divided into three sub-types, defined by various levels of inattention and hyperactivity-impulsivity. Although the mechanisms of ADHD are not yet fully understood, thinking about the nutrient quality of your diet is always a smart move. Here’s a brief summary of some nutritional interventions that might be worth a try:

1. Elimination Diets: Food elimination diets can take various forms, including single food and multi-food exclusion diets, or alternatively ‘few foods’ diets. Elimination diets are designed to remove foods expected to be problematic for a defined period of time, and consecutively reintroduced to track response. A review published by Stevens et al. (2010)concluded that a “trial elimination diet is appropriate for children who have not responded satisfactorily to conventional treatment “, quoting two large studies indicating behavioral sensitivities to artificial food colors and benzoate. In 2011, The Impact of Nutrition on Children with ADHD (INCA) studywith 100 children 4-8 years old utilized a restricted elimination diet over five weeks. During the following four weeks, crossover food challenges were completed with relapse of ADHD symptoms occurring in 19 out of 39 (63%) of children. Nigg & Holton (2014)outline a list of additives which could hold promise for improving ADHD symptoms when removed:

• All artificial colors
• All artificial flavors
• All artificial sweeteners, including aspartame, acesulfame K, neotame, saccharin, sucralose
• Sodium benzoate
• Butylated hydroxyanisole and Butylated hydroxytoluene
• Carrageenan
• Monosodium or monopotassium glutamate
• Any hydrolyzed, textured, or modified protein

2. Micronutrient Status: Spectracell Laboratories provides a summary of the role of various micronutrients, including B6, Magnesium, Zinc & Choline. You can check it out here. 

Zinc: In a 2011 trial of zinc supplementation, 52 children aged 6-14 years of age were randomized over 8 weeks to zinc glycinate supplementation or to placebo. Among those children receiving (15mg BID),  a 37% reduction in amphetamine optimal dose was seen. Zinc deficiency has been linked to ADHD symptoms for more than 20 years, with known symptoms of zinc deficiency including impaired concentration. Zinc  status impacts structure and function of the brain, and indirectly affects dopamine metabolism. It seems that dopamine and norepinephrine, catcholamines with central roles in attention, operate on a U-based pool, where an appropriate level is needed for optimal functional of the pre-frontal cortex (source). High dose and prolonged zinc supplementation can cause impairment of iron and copper metabolism, so the safest first bet might be to focus on intake of Zinc rich foods (source).

Regardless of what trials show about isolated nutrient supplementation, it’s important to think about the whole dietary pattern. A trial of 100 patients showed that the “nutritional status in the ADHD group was significantly lower (P < .05) than in the control group”. Among the ADHD study group participants, consumption of consumption of cereals, meat, pulses and fruits as well as protein, carbohydrate, fat, fiber, calcium, iron, magnesium, zinc, selenium, phosphorus, thiamine, vitamin B6 & folate intake was significantly lower in the ADHD group than in the control group.  Although some trials have shown promise with nutrient supplementation, it should be understood that supplementation of some nutrients in excessively high dosage has the potential to disrupt balance of other nutrients, while nutrient supplementation can not offer the same array of nutrient compounds that whole foods would. A valuable first step always is to assess nutrient intake through whole foods.

3. Fatty Acid Status: What is your brain made of? In large part, fatty acids! Highest fatty acid concentrations are palmitate (16:0), arachidonic acid (AA,20:4n-6), and the long-chain fatty acids docosahexaenoic acid (DHA) & eicosapentaenoic acid (DPA). Brain phospholipids are enriched with high levels of DHA (although both DHA and EPA can increase membrane phospholipids), which maintain protein activity, membrane fluidity, and phase behavior (source). Although results of DHA/EPA supplementation have been mixed with attention deficit disorder, Omega-3 deficiencies correlate with behavioral problems including conduct disorder, hyperactivity-impulsivity, anxiety, temper tantrums, and sleep difficulties). A diet rich in Omega-3 fatty acids would include fatty fish and plant-based alpha-linolenic acid (flaxseed, chia seeds)-remember that conversion from plant-based to long-chain fatty acids are genetically determined.

When thinking about ways design your diet around high levels of nutrient-dense foods and adequate levels of fatty acids, the Mediterranean diet pattern could provide some inspiration. Check out the Oldways websitefor inspiration & resources that can help to put this dietary pattern into action.

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