The treatment of attention deficit/hyperactivity disorder (ADHD) remains controversial, and there are currently no known treatments that lead to a cure. Methylphenidate (Ritalin) is the most well-known pharmacologic treatment for children with ADHD.
Nutritional treatments are not well-studied, so there is much to be understood about how nutrition may influence ADHD. Sugar consumption often is blamed as a cause of ADHD; however, little compelling evidence demonstrates a cause-effect relationship. While I think we would all do well to avoid sugar and aspartame as a general rule for good health, there seems to be no support for the emotional arguements about sugar and ADHD. The NIMH reported the outcome of one related study:
"Children whose mothers felt they were sugar-sensitive were given aspartame as a substitute for sugar. Half the mothers were told their children were given sugar, half that their children were given aspartame. The mothers who thought their children had received sugar rated them as more hyperactive than the other children and were more critical of their behavior."
The results of this study hardly support the notion that we should feed ADHD children sugar. In fact, the opposite is quite true and it applies to all of us. We can only consume so many calories in a day, and we should do our best to make sure each calorie comes from nutrient-dense foods. Vegetables, fruit, raw nuts, and omega-3 animal products are our best options.2-4 Grains, legumes, dairy, refined sugar/flour, and sugary beverages are simply not healthy options, and so are not recommended.2-4 I refer to this as an anti-inflammatory diet.4
Will eating healthy foods help ADHD symptoms? It is possible and many claim yes; however, a more rational view should be that we want a child who suffers with ADHD to be otherwise healthy, and we can create a nutritional/biochemical environment that is most conducive to reducing ADHD symptoms and preventing the development of a chronic disease.
Nutrition for the Nervous System and Mental Function
My personal feeling is that we should all eat an anti-inflammatory diet, as outlined earlier,2-4 and take at least a multivitamin/mineral, magnesium, and EPA/DHA from fish oil.4 The following information suggests this approach may be useful in helping to treat ADHD.
Magnesium is one of the most important minerals for humans to consume, as it is involved with 300-plus metabolic reactions. A recent study conducted by researchers at the Centers for Disease Control demonstrated that magnesium intake among adult Americans is depressingly low, ranging from 70-140 mg below the RDA.5 The authors list numerous conditions that are associated with magnesium deficiency, such as cardiovascular disease, hypertension, diabetes mellitus, headaches and asthma.5
Magnesium also is known to be a key nutrient in the modulation of nervous system excitability and the biological clock. Dr. Jean Durlach, the editor of the journal Magnesium Research, has written the most detailed description of these relationships.6-7 In all animals studied to date, magnesium deficiency leads to varying degrees and expressions of increased inflammation and nervous system hyperexcitability.6 The general nervous system theme is an increase in the activity of excitatory neuromediators such as acetylcholine, catecholamines, and the excitatory amino acid neurotransmitters, aspartate and glutamate. This increased excitability is coupled with a decrease in the activity of inhibitory transmitters, such as GABA, taurine, glutaurine and opioids.6
We can create a nutritional/biochemical environment that is most conducive to reducing ADHD symptoms and preventing the development of a chronic disease.
As reduced magnesium intake leads to hyperexcitability, it would not be unreasonable to hypothesize that increasing magnesium intake would lead to reduced nervous system excitability and have a positive effect on children with ADHD. A handful of studies have been performed in this regard.
Most recently, researchers in France supplemented 40 ADHD children (average age: 6.5 years) with magnesium (6 mg/kg body weight) and vitamin B6 (0.6 mg/kg body weight) for at least eight weeks.8 Changes in hyperactivity, hyperemotivity/aggressiveness, and attention at school were scored at different times during the study period. After eight weeks, there was a significant improvement in all measured parameters of activity and attention. The symptoms returned shortly after supplementation was discontinued. Interestingly, the ADHD subjects had significantly reduced erythrocyte magnesium levels (serum is an inaccurate measure of tissue stores) compared to controls (2.05 mmol/L vs. 2.73 mmol/L). After supplementation, erythrocyte levels of magnesium rose to 2.35 mmol/L. These outcomes are consistent with an earlier trial published by these authors,9 who indicated additional and longer trials are needed.
The use of a multivitamin/mineral supplement also may be helpful for those with ADHD. Schoenthaler has pioneered the work involving nutritional imbalances and anti-social behavior. While he has not worked with ADHD sufferers specifically, he has worked with delinquent adolescents who manifested a variety of antisocial behaviors, including threats/fighting, vandalism, being disrespectful, disorderly conduct, defiance, obscenities, refusal to work or serve, endangering others and various nonspecified offenses. In one study, Schoenthaler investigated whether 468 schoolchildren, ages 6 to 12 years, who were given low-dose vitamin-mineral tablets would produce significantly less violence and antisocial behavior in school than classmates given placebos. Daily vitamin-mineral supplementation was 50 percent of the U.S. recommended daily allowance (RDA) for four months versus placebo. The supplement was designed to raise vitamin-mineral intake up to the levels currently recommended by the National Academy of Sciences for children ages 6 to 11 years, which led to an almost 50 percent reduction in institutional violence and antisocial behavior.10 While these adolescents were not diagnosed with ADHD, the uncontrollable antisocial behavior was not categorically dissimilar from those suffering with ADHD.
Omega-3 fatty acids also may be a useful nutritional supplement. As with magnesium and multivitamins, there is limited research available on omega-3 fatty acids and ADHD. However, preliminary data suggest that increasing omega-3 fatty acids will be useful.11 For example, research demonstrated that subjects with lower compositions of total n-3 fatty acids had significantly more behavioral problems, temper tantrums, and learning, health and sleep problems than those with high proportions of n-3 fatty acids.11 See Kidd's review for more details on the nature of ADHD and its pharmacologic and nutritional treatment.12
References
- See www.nimh.nih.gov/publicat/adhd.cfm#cause.
- Franco OH, Bonneux L, de Laet C, Peeters A, Steyerberg EW, Mackenbach JP. The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%. Brit Med J 2004;329:1447-50.
- Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, O'Keefe JH, Brand-Miller J. Origins and evolution of the Western diet: Health implications for the 21st century. Am J Clin Nutr 2005;81:341-54.
- Seaman DR. "Nutritional Considerations for Pain and Inflammation." In Liebenson CL (editor): Rehabilitation of the Spine: A Practitioner's Manual, 2nd ed. Baltimore: Williams & Wilkins; 2006: p.728-740.
- Ford ES, Mokdad AH. Dietary magnesium intake in a national sample of US adults. J Nutr 2003;133:2879-82.
- Durlach J, Bac P, Bara M, Guiet-Bara A. Physiopathology of symptomatic and latent forms of central nervous hyperexcitability due to magnesium deficiency: a current general scheme. Magnes Res 2000;13(4):293-302.
- Durlach J, Pages N, Bac P, Bara M, Guiet-Bara A, Agrapart C. Chronopathological forms of magnesium depletion with hypofunction or with hyperfunction of the biological clock. Magnes Res, December 2002;15(3-4):263-8.
- Mousain-Bosc M, Roche M, Polge A, Pradal-Prat D, Rapin J, Bali JP. Improvement of neurobehavioral disorders in children supplemented with magnesium-vitamin B6. I. Attention deficit hyperactivity disorders. Magnes Res 2006;19(1):46-52.
- Mousain-Bosc M, Roche M, Rapin J, Bali JP. Magnesium-VitB6 intake reduces central nervous system hyperexcitability in children. J Am Coll Nutr 2004;23(5):545S-548S.
- Schoenthaler SJ, Bier ID. The effect of vitamin-mineral supplementation on juvenile delinquency among American schoolchildren: a randomized, double-blind placebo-controlled trial. J Altern Complement Med 2000;6:7-17.
- Burgess JR, Stevens L, Zhang W, Peck L. Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. Am J Clin Nutr 2000; 71(suppl):327S-30S.
- Kidd P. Attention deficit/hyperactivity disorder (ADHD) in children: rationale for its integrative management. Altern Med Rev 2000;5:402-28.
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