ADHD: Nutritional Deficiencies, Vitamin Supplements and Diets
Vitamin deficiency, leaky gut and gut microbiota issues are well established disrupters. Medical research has now confirmed that blood tests of children and adults with ADHD symptoms confirm peculiar micronutrient deficiencies. Diet and digestion play a role with certain foods such as sugar, food colourings and salicylates documented to aggravate the inattention, impulsivity and mood dysregulation.10
ADHD medication2 with known side-effects of reduced appetite and weight-loss, encourage picky eating- potentially further worsen pre-existing deficiencies.
Prescribing doctors thoughtfully, sometimes, suggest a ‘drug holiday’, during which the child can eat more and gain weight to ensure healthy growth and development.3
Would these periods of normal eating be enough to tackle and restore underlying deficiencies? Especially when the vitamin levels were possibly deficient before diagnosis or before starting medication for ADHD?
Let’s first understand the known nutritional and physiological issues surrounding ADHD.
Lower than normal levels of Vitamin D, Zinc, Magnesium, B6, Folate and Iron have all been documented in diagnosed ADHD patients. Supplementing the required vitamins and micronutrients has shown relief of key symptoms.6,1,5,8,7
Children with allergies have shown a higher risk of an ADHD diagnosis. Higher levels of circulating immune complexes such as mast cell markers and antigen specific immunoglobulins have shown a negative impact on behavior, motor skills and learning.4
Food intolerances defined as an adverse physiologic response to certain foods have shown behavioural consequences in susceptible children.9
Gluten-free and low sugar diets have also shown ‘statistically significant and clinically relevant positive effects on ADHD symptoms.10
Double blind placebo controlled trials have confirmed the efficacy of the ‘Few Foods Diet’ and elimination of artificial food colourings. This approach has been suggested in kids too young for medication, for those on medication with digestive issues and continued attention problems. This study identified a certain subtype of ADHD children that respond well to nutritional therapy when implemented by trained therapists.11,13
The International Society for Nutritional Psychiatry Research has confirmed the interplay between nutrition, genetics and environmental factors. They have suggested that nutrient based therapies and augmentation therapies cannot be ignored due to the amount of evidence.12
So what would be the best method to nutritionally support a person with ADHD?
ADHD is a multifactorial condition. It is important to remember that each individual is different. Though they may have common features of ADHD, their vitamin levels, genetic, environmental pictures may vastly differ.
On conventional medication or without, a precision nutrition approach is best, rather than an over-the-counter supplementation. There is no ‘one size fits all’ approach though nutraceutical advertisements and social media may suggest otherwise.
Appropriate screening, monitoring, along with an individualized diet and supplementation under the guidance of a trained professional would support reduction in known deficiencies, improvement of digestion and gut microbiome, encouraging relief of symptoms.
1. Bilici, M., et al., Double-blind, placebo-controlled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2004. 28(1): p. 181-190.
2. Bolea-Alamañac, B., et al., Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: update on recommendations from the British Association for Psychopharmacology. J Psychopharmacol, 2014. 28(3): p. 179-203.
3. Briars, L. and T. Todd, A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2016. 21(3): p. 192-206.
4. Costa-Pinto, F.A. and A.S. Basso, Neural and Behavioral Correlates of Food Allergy. Chemical Immunology and Allergy, 2012. 98: p. 222-239.
5. El Baza, F., et al., Magnesium supplementation in children with attention deficit hyperactivity disorder. Egyptian Journal of Medical Human Genetics, 2016. 17(1): p. 63-70.
6. Hemamy, M., et al., The effect of vitamin D and magnesium supplementation on the mental health status of attention-deficit hyperactive children: a randomized controlled trial. BMC Pediatrics, 2021. 21(1): p. 178.
7. Konofal, E., et al., Effects of iron supplementation on attention deficit hyperactivity disorder in children. Pediatr Neurol, 2008. 38(1): p. 20-6.
8. Mousain-Bosc, M., et al., Improvement of neurobehavioral disorders in children supplemented with magnesium-vitamin B6. I. Attention deficit hyperactivity disorders. Magnes Res, 2006. 19(1): p. 46-52.
9. Ortolani, C. and E.A. Pastorello, Food allergies and food intolerances. Best Practice & Research Clinical Gastroenterology, 2006. 20(3): p. 467-483.
10. Pelsser, L.M., et al., Diet and ADHD, Reviewing the Evidence: A Systematic Review of Meta-Analyses of Double-Blind Placebo-Controlled Trials Evaluating the Efficacy of Diet Interventions on the Behavior of Children with ADHD. PLoS One, 2017. 12(1): p. e0169277.
11. Pelsser, L., et al., Retrospective Outcome Monitoring of ADHD and Nutrition (ROMAN): The Effectiveness of the Few-Foods Diet in General Practice. Front Psychiatry, 2020. 11: p. 96.
12. Sarris, J., et al., Nutritional medicine as mainstream in psychiatry. (2215-0374 (Electronic)).
13. Stobernack, T., et al., Biomarker Research in ADHD: the Impact of Nutrition (BRAIN) – study protocol of an open-label trial to investigate the mechanisms underlying the effects of a few-foods diet on ADHD symptoms in children. (2044-6055 (Electronic)).