ADHD, Nutritional Imbalances
And Other Tips
ADHD – Attention deficit/hyperactivity disorder (formally known as ADD-Attention Deficit Disorder) is the most common behaviour condition in children that often continues into adulthood. ADHD is not a ‘Ritalin deficiency’, yet the use of these drugs is skyrocketing. In fact, the global use of ADHD medication rose 3 fold from 1993 to 2000.
Since when did this become a normal consequence of being a child? When I was at school (it wasn’t that long ago) we had maybe one troubled kid in the classroom. How did we go from that to one in ten kids with ADHD today? The real question becomes what causes ADHD, and why is it so prevalent?
Although many children “grow” out of ADHD, or at least do not meet criteria for ADHD as adults, there are many adults who do have ADHD. These adults are rarely visibly hyperactive, but they may be restless or fidgety. More importantly, their lack of focus and organization, as well as impulsivity, can cause severe problems, both at home and at work. Statistically, they have higher rates of divorce and unemployment resulting from these issues. Although likely over-diagnosed recently, true ADHD in adults can be a very significant and debilitating issue.
ADHD is much more common among males than females. It is estimated that boys are two to three times more likely to have ADHD than girls. They are up to nine times more likely than girls to be referred for evaluation and treatment.
It is important to remember that ADHD is a syndrome that must be seen in “context.” One teacher may see a child’s behaviour as a major problem, whereas another teacher may see the exact same behaviour as a mild challenge. This is especially common among less severe cases, which are the majority of cases diagnosed. For an accurate diagnosis, symptoms must cause impairments in more than one setting (such as in multiple classrooms, or both the classroom and the home), as well as among multiple supervising adults.
In an effort to understand this disorder, a lot of research has been done over the years. Clinical studies link ADHD with several nutritional imbalances, some of them resulting from an overall unhealthy diet. Other studies connect ADHD with specific nutrients such as minerals, vitamins and essential fatty acids.
Signs, Symptoms and Causes
Everybody is different. ADHD is just a name we give to people who share a collection of symptoms: They can’t focus or pay attention, they’re inattentive, and they are hyperactive. What is often confusing and very frustrating for parents is that in all but the most severe cases, this difficulty focusing is not present in all areas. Some ADHD children may focus very well on building with Legos, art, sports or even reading things they like. It is when they are called upon to exert mental energy doing things that are challenging that the focus issue becomes most prominent. (Most children with ADHD can focus on watching television or video games, so this is no help at all in arriving at a diagnosis).
ADHD, like many syndromes, is felt to be caused by a combination of genetic and environmental factors. ADHD certainly runs in families. Estimates are that 70 to 80 percent of the incidence of ADHD is genetically related. Indeed, it is unusual for me to see a child with ADHD who does not have a parent or close relative who has ADHD, whether diagnosed or not. There are many different genes that have been associated with ADHD, with no specific gene having a strong association. This makes it unlikely that any particular genetic therapy will have a significant effect, at least in the near future.
There are a number of environmental factors from pregnancy onward that may as well cause the development of ADHD. Brain injury at any time before or after birth, premature birth, low birth weight and alcohol or tobacco use during pregnancy all have been linked with an increased incidence of ADHD.
Many influences that occur after birth are associated with increased rates of ADHD. These include birth trauma, seizures in the new-born and any type of brain injury. Exposure to environmental toxins through childhood can also plays a significant role.
Parenting and Schooling
These are extremely important for all children but even more so with ADHD children. Although less than optimal parenting does not cause ADHD, it can be a significant contributor to a child’s development, self-esteem and eventual success. Children with ADHD can be very difficult to parent, especially those who are hyperactive and oppositional, which is often the case. Frequently parents become frustrated and angry at the difficulty of raising such children. The parenting techniques they have seen other parents use successfully or may even have been effective with their other children are completely unsuccessful when it comes to ADHD children. They then may become engaged in a repetitive cycle of anger and criticism on the one hand, combined with allowing unacceptable behaviour on the other hand. Parents and their children need help with learning to regulate (and teach their children to regulate) their behaviour. ADHD children have not been shown to respond to conventional therapy, parent training of various kinds has been shown to be ineffective. This is where Heartmath can be very valuable. There are a number of different behavioural and parenting techniques available but my experience with Heartmath has proven to be very successful. It gives parents a system they can use and a way to get help. The difference in a child’s self-esteem and ability to succeed can be dramatic. You can read more about Heartmath below.
When it comes to schooling, placement is extremely important. An ADHD child can have severe difficulties in one grade followed by a great year the next — the sole difference being the fit between the teacher and child. Therefore, proper school placement is extremely important. All children who have ADHD should have reasonable accommodations within the classroom. This can involve extra time for tests, decreased volume of homework, sitting at the front of the room and other simple modifications that can make a really significant difference for certain children.
Outside of school, it is important to encourage success in other areas. Children with ADHD should be allowed to spend time at things they like and do well, whether it is sports, art, martial arts, music, spending time in nature or just playing with friends. It is not helpful to decrease these activities in order to spend even more time on school work. It is discouraging to children and bad for their self-esteem. Remember that school is difficult for ADHD children, and it can be discouraging for anybody to spend all day doing things which are difficult to them.
There are a number of behavioural, dietary and lifestyle treatments for ADHD, which should be considered before or even along with medication, but for this section let us focus on medication treatment for ADHD.
The backbone of medications for ADHD are the psychostimulants. The most well-known of these is methylphenidate (Ritalin) and its derivatives, such as Concerta and Focalin. There is also another line of psychostimulant medications derived from Dexedrine, such as Adderall or Vyvanse. All of these psychostimulants have similar effects. Their main mechanism of action appears to be increasing the availability of dopamine and norepinephrine to the frontal lobe and other regions of the brain. This has the effect of increasing the ability of the frontal lobe in particularly to do its role of executive functioning.
You might ask, why not give every child diagnosed with ADHD a dose of these medications. There are two reasons. First, there a number of side-effects associated with medication use. Those include appetite suppression, sleep problems, growth delay, tics, headaches, anxiety, depression, irritability and aggression. One to three percent of those taking psychostimulants will experience hallucinations. These medicines can also produce personality changes that are harder to define. I often will hear parents say “he is just not himself” or “he’s lost her joy.”
Several long-term studies that have been done with these medications have failed to show any long-term benefit. However, there is no evidence that these medications, used as prescribed, are physically or psychologically addictive. On the other hand, psychostimulants do have a significant potential for abuse.
There are a number of effective “alternative” treatments for ADHD. Many of these treatments are defined as alternative simply because they are an alternative to medication, not because they are a complimentary treatment. Particularly, some of the nutritional treatments described below are based on basic Western science and should be evaluated as such.
One important area of treatment is dietary modification. A healthy diet is critical. Sugar, artificial colours and flavours and preservatives and highly processed carbohydrates should be avoided or kept to a minimum. Each meal, especially breakfast and lunch, should have healthy protein and minimally processed carbohydrates. Healthy fats are especially important. Avoid all trans fats, and keep saturated fats at reasonable levels and preferable from plant based sources. Adequate amounts of fruits and vegetables are needed to maintain antioxidant status.
Many parents ask how they can get their children to change their diets and eat healthier foods. The answer is that you can’t make children eat what they do not want to eat, but you can stop buying and offering what you do not want them to have. Eventually they will make a choice out of the healthy foods that are on offer. A final word: You do not need to be too strict. Everyone should be able to have an occasional treat. Unless there is a food intolerance, it is what the child eats on a regular basis that makes a difference.
As I mentioned above, dietary modification is critical. First, many children with ADHD are “intolerant” to certain foods — most commonly gluten and casein (a protein found in cow’s milk), but sometimes soy, corn, eggs or others. This means that these foods worsen ADHD symptoms in certain children. I use the word “intolerant” rather than “allergic” because these children typically do not have measurable food allergies. Several studies have shown that placing children with ADHD on elimination diets results in substantial improvement in a significant number of children. Elimination diets can be difficult for families, but usually children are only sensitive to one or two foods, and the significant improvement in symptoms make it quite worthwhile.
A good alternative to an elimination diet which give quick and very accurate results is having a food intolerance test done. While testing can reveal specific sensitivities, you should be aware that partially digested dairy and wheat particles (called caseomorphins and gliadomorphins) are found in the urine of severely depressed patients (as well as children with autism and ADHD). I recommend a complete 100% elimination of all gluten and dairy foods for a full six weeks.
Similarly, it is quite clear that artificial colours, flavours and preservatives often worsen ADHD symptoms. In fact, they can cause children without ADHD to have increased hyperactivity and decreased attention. You may have seen food labels that say “may have an adverse effect on activity and attention in children.” The research on sugar is not so clear, but it is hard to ignore the fact that many families notice a dramatic worsening in ADHD symptoms when too much sugar is eaten. Sugar laden foods cause an immediate jump in blood sugar, followed by an outpouring of insulin and a result in low blood sugar, which can cause a child to be jittery, fidgety, irritable and unable to pay attention.
A healthy diet should be made of real, whole foods. It should be free of additives, sugar, trans fats, and processed foods. There is a close connection between the obesity epidemic we are seeing and the epidemic of ADHD and behaviour problems in children.
Inflammation has been linked to almost all brain problems such as autism, ADHD, Alzheimer’s, and depression. These and other diseases are all related to elevated levels of cytokines and systemic inflammation. They can cause problems in every organ, in every part of the body. Besides supplementing with fatty acids, you should consider an anti-inflammatory diet rich in antioxidants (plenty of colourful plant based foods) and in wild-caught fish and plant foods like avocado and flaxseed.
Detoxification from Medication
An overload of heavy metals in children who are genetically susceptible to their effects is one of the underlying causes of ADHD. Each individual responds differently to toxins. Some are great detoxifiers; others, like those with ADHD, are often not. Every child with behaviour problems— whether it is ADHD, autism, or something else— is unique. Each has to find his or her own path with a trained healthcare practitioner. You must not forget that getting off medications can be tough, come with certain risks, and must be done under a physician’s supervision. I don’t recommend anyone stop using their medications suddenly. At the same time, following a plan to optimise brain function and address the underlying causes of mood disorders and brain dysfunction can help many people to get off their medications with their physician’s help and feel better and healthier than ever.
Addressing Nutrient Deficiencies
Many nutrient deficiencies, including magnesium, zinc, selenium, tyrosine, and fatty acids, play significant roles in the development of ADHD. Many of these nutrients work better when taken together. A Functional Medicine practitioner can custom-design a nutrient plan. You may find all these supplements in my online shop.
Testing for nutrient deficiencies is available through several advanced laboratories throughout the world. There are tests that are based on urine analysis, blood analysis or both. The tests that I recommend are:
ONE profile (Optimal Nutritional Evaluation)
NutrEval (Only available in the UK and USA)
Organix comprehensive profile (especially suitable for children)
Fish Oil - A very simple nutritional intervention is the addition of omega-3 fatty acids to the diet, usually in the form of fish oil. Omega-3 fatty acids are a type of fat that are extremely important to normal neurological function. Interestingly, children with ADHD are often deficient in omega-3 fatty acids for reasons that are yet not known. Merely increasing weekly fatty fish portions is unlikely to help, therefore I recommend supplementing with essential fatty acids.
Iron and Zinc - A very interesting nutritional fact is that children with ADHD have lower levels of iron circulating to their brains compared to children without ADHD. Several studies have confirmed this. Further research has shown that in those children with low levels of iron, treatment with an iron supplement can have a positive impact on ADHD symptoms. It is important to note that this is measured by checking “serum ferritin” These children are not anaemic. Since iron can be overdosed, it is important to check a ferritin level before beginning any iron therapy. There has been similar research, although it as not as clearly proven, about the role of zinc in ADHD. One interesting study showed that giving a zinc supplement decreased the amount of medication necessary to achieve good results by almost 40%.
Magnesium - Low-magnesium levels lead to headaches; anxiety; insomnia, muscle spasms, cramps, and aches; and hypersensitivity to noises. Because magnesium is a mineral that calms the nervous system, many people wonder if it is helpful for ADHD. There has been some nonconclusive research on the subject. A series of articles, mainly from Poland, in the late 1990s, indicated that children with ADHD had low levels of magnesium and that magnesium supplements might improve ADHD symptoms. There was no control group used in these studies, so the research is not convincing. Little research has been done since. I think taking a reasonable dose of magnesium is fine if patients would like to experiment with it. Sometimes it is helpful for relaxation and sleeping. Pure magnesium oil is another great way of getting magnesium, by absorption through the skin.
Tyrosine - Tyrosine is helpful in relieving stress, building adrenaline stores, improving mood and in improving mental acuity. Tyrosine may be helpful with ADHD. Dopamine is produced from the amino acid tyrosine with the help of iron, vitamin C, folate, vitamin B6 and tetrahydrobiopterin. Low dopamine levels impair attention and focus. Some studies show that children suffering from ADHD usually have low levels of Tyrosine. Some parents of Autistic kids report improvement in speech and fewer sensory issues when supplementing with Tyrosine. As dopamine controls the flow of information to the other parts of the brain which occurs in the frontal lobes (called the prefrontal cortex), it is not surprising that taking L-Tyrosine supplement that increasing dopamine may be beneficial in mood regulation often problematic in ADHD.
Several of these may have an impact on ADHD. A study published recently demonstrated that ginkgo biloba , an herb long known for its positive effect on cognition, increased the benefit of methylphenidate by 35%.
Exercise and sports
These are very important for ADHD children. Many families find that getting their child an hour or two of exercise makes a dramatic difference in their level of functioning. This has been confirmed by multiple research studies. The type of exercise an ADHD child will enjoy is very individual. Although some ADHD children love and succeed at team sports like soccer or basketball, many dislike the complex rules and periods of inactivity required. These children are likely to do a lot better with an individual sport such as tennis, gymnastics, dance or swimming. Martial arts, with its emphasis on concentration and discipline, can be extremely helpful and satisfying for some ADHD children. Some may just love riding their bicycle.
Being in nature can also be very helpful. Lack of exposure to nature may be one more reason for the dramatic rise in the incidence of ADHD.
Video games, computer and screen time is another very important issue. Many children are spending excessive amounts of time staring at a screen. Including homework, some are using electronics during most of their non-school waking hours. There is conclusive evidence correlating increased screen time with worsening ADHD symptoms. Some children become seriously obsessed with and addicted to online or individual video gaming. This is an issue every parent must deal with individually because it is becoming increasingly unrealistic to ban screen time altogether, but parents need to make a decision about reasonable limits and be consistent with it.
There are several of what is referred to as “mind-body” techniques that can help focus the ADHD child. Preliminary studies indicate that yoga and meditation may be helpful. There is a particular type of meditation/stress-reduction technique called Heartmath, which has shown particular promise in several studies. It has the advantage of not being tied to any particular religion or spiritual path. Heartmath also has several biofeedback how to change abnormal brain wave patterns.
Many parents, teachers and therapist have shared stories of their success using the emWave PC or emWave Personal Stress Reliever® (PSR). If your child is over 8 years old, I recommend the emWave PC or emWave2; both are heart coherence monitors and are being used in schools around the world. They have charts, graphs, games and lights most children enjoy.
No one chooses to “have ADHD.” But whilst having the disorder is not anyone’s fault, managing ADHD is ultimately the individual’s responsibility. Successful living is based on self-awareness and self-understanding, both of which can be supported by an accurate and clear diagnosis of ADHD. Next, coaching and skill-building can reinforce ownership of ADHD symptoms by helping an individual understand the disorder and how it affects them. By developing strategies for circumventing limitations and designing a lifestyle that capitalises upon advantages, ADHD becomes just another part of life. And like life, ADHD is simply what you make of it.