Using Nutrition to Manage ADHD

My child was diagnosed with ADHD and I was told he needs to start conventional medication. I have seen a lot of information about alternative therapies, including different diets, but are they safe? Do they work? How do I know which one(s) to try?

Attention Deficit Hyperactivity Disorder, or ADHD, manifests as inattentiveness, hyperactivity and impulsivity, or some combination of these. While the exact cause of ADHD remains unknown, we do know several factors can lead to its development. As a result, treatment is highly individualized and often involves a combination of several approaches designed to alleviate associated symptoms. Treatment approaches include medication, behavioral counseling, education and training.

In addition to these treatment options, many recommendations have emerged as an alternative or supplemental therapy to help manage symptoms of ADHD. These dietary modifications can be confusing to both the caretaker and the individual. They are often complicated and difficult to apply. In an effort to clear up some of the confusion, here is a brief overview on some of the most popular recommendations and what research has to say about them.

*Before reading, please note that this information is not intended to replace medical recommendations and its application should be considered under the guidance of a registered dietitian.

  • Sugar-restricted Diet: The theory behind this diet is that eating excessive amounts of refined sugar worsens symptoms of ADHD. Many individuals and caretakers report this to be true for themselves and/or their children. Surprisingly, some studies do not show a connection between excess sugar consumption and ADHD symptoms. However, there is plenty of anecdotal evidence that leads people to still give it a try! Take Home Message: This diet is safe to try with your child, but do not expect drastic changes in behavior simply from removing added sugars. Regardless of whether sugar does or does not affect ADHD symptoms significantly, it is beneficial to limit the amount of added sugars in our diets for general wellness.
  • Additive/Preservative-free (The Feingold Diet): This modification requires avoiding certain foods thought to cause adverse reactions in children with ADHD. The foods in question are those containing dyes and preservatives, particularly red, orange, and yellow synthetic dyes. For example, you can recognize dyes such as red #40 or yellow #5 from food labels on the ingredients lists. You might also look to avoid preservatives, such as BHA, BHT and TBHQ. These types of additives are often found in processed foods and are listed on the nutrition facts label. Research provides inconsistent evidence about the effectiveness of this diet; however, some children do benefit from the elimination of these items. Take Home Message: Remember, making these adjustments may or may not alleviate your child’s ADHD symptoms. However, this diet is safe to try, and by eliminating or limiting the amount of packaged and processed foods in the home, you are making positive, healthy changes for your entire family.
  • Oligoantigenic (Elimination Diet): This diet eliminates well known food antigens, which cause an immune response in the body, and allergens, which cause an allergic reaction, in hopes of identifying foods that might trigger ADHD symptoms. Symptoms are alleviated when the “problem-foods” (the antigens or allergens) are removed from the diet. Several foods are eliminated all at once in hopes that the symptoms subside. Then, foods are reintroduced one at a time to determine which one(s) are the culprit for influencing symptoms and therefore should be permanently eliminated. As with the previous two diets, research is mixed about the effectiveness of this approach in treating individuals with ADHD. Take Home Message: Eliminating certain foods from the diet may improve some symptoms associated with ADHD. However, if you are going to attempt this type of diet, it is imperative you work with healthcare professionals, including a dietitian, to ensure your child continues to meet their nutritional needs. If you have an interest in this, please ask our registered dietitians about the Lymphocytic Response Assay Testing (LRA) and read more about it here.
  • Ketogenic Diet: This is a diet that is high in fat and low in carbohydrate and is sometimes used for the treatment of epilepsy. Not much is known about how the diet works, but it can have an anti-epileptic effect. What does this have to do with ADHD? Children with epilepsy often have ADHD symptoms and children with ADHD sometimes have epileptiform discharges in an electroencephalography (EEG). Please note, this is very rare and would be best diagnosed by a medical doctor. It is thought that if a child with ADHD experiences these epileptiform discharges, the ketogenic diet may be beneficial. There are few, if any, scientific studies testing this diet and its effects on a child with ADHD. Take Home Message: It is NOT recommended to use the ketogenic diet to alleviate symptoms associated with ADHD alone, but may be an effective approach if ADHD exists with epileptiform discharges in an EEG.
  • Omega 3 and 6 Fatty Acid Supplementation: It is thought that children with ADHD may have lower levels of essential fatty acids (EFAs) compared to children without ADHD. As a result, several studies have looked at whether supplementing these fatty acids in children with ADHD would alleviate symptoms associated with the disorder. Surprise, surprise: results of the studies are inconclusive! Fatty acid supplementation is beneficial for some kids and was shown to be ineffective in others. This treatment approach is not always effective, but in most cases is not harmful to try and can have other health benefits for a child. Take Home Message: Essential fatty acids alone are not an effective tool for ADHD management. However, it might be beneficial to ensure adequate intake of these nutrients in children who are deficient. Consider talking with a registered dietitian about the amount and type of supplementation your child might need. You might consider adding foods that are high in these nutrients, including ground flax seed (make sure you store in a freezer or refrigerator!), walnuts, and high fat cold water fish (e.g., salmon, herring, mackerel, trout, chunk light tuna canned in water).
  • Megavitamin Supplementation: This type of supplementation might refer to taking mega-doses of multivitamins, individual vitamins, and/or minerals to create an “optimal molecular environment” for the functioning of the mind. Research shows this type of therapy is not effective for management of ADHD and related symptoms. As a matter of fact, excessive intake of some vitamins can be toxic to our bodies and cause adverse reactions. Take Home Message: DO NOT use megavitamin supplementation as a means to manage ADHD. It is only recommended to consume vitamins and minerals in levels that exceed the RDA (recommended daily allowance) under the specific recommendations of a health care professional due to their potential toxicity.

You might be thinking, “Wow. This is a lot of information and I still feel confused. So, should I change my child’s diet to manage their ADHD or not?” Well, research shows that diet alone may not be an effective management tool for children with ADHD. Since the cause of the disorder is multifactorial, medical experts recommend using a combination of medication, supplementation, and/or behavioral therapies to treat the disorder. Since diet is a modifiable aspect that might affect the disorder, it could be worth adding it to that list to try as a supplemental therapy.

Initially, focus on regular meal times (i.e., encouraging your child to eat every 3-4 hours) to promote stable blood sugar levels. Aim for a well-rounded healthy diet since it is beneficial for any developing child. This would include focusing on lean meats, fruits, vegetables, whole grains and low-fat dairy products. In doing so, less emphasis is placed on added sugars and processed foods, thereby eliminating some of the potentially problematic foods. You never know: making these changes might lead to less reliance on conventional medications.

If you are serious about trying one of the aforementioned diets to manage ADHD symptoms, it is important to recognize that these types of diets can be complex, time-consuming, and disruptive to the rest of the family. They require a lot of patience and perseverance. It is vitally important to work with a registered dietitian who can help you with meal planning, stocking your pantry with safe items, and recommend supplements as needed. Find a team of healthcare professionals who support your decision and are able to provide their expertise along the way.

If you are interested in learning more about how ADHD might be related to diet or to schedule a nutrition consultation with a dietitian, please contact us at 713-365-9015 or email heritage@heritagebehavioral.com.

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Special thanks to Ms. Mara Mcguin for her assistance in creating the above article. Mara was a previous dietetic intern at Heritage Behavioral Health Consultants and is now a newly credentialed Registered Dietitian in the Colorado area.

References:

–  Center for Science in the Public Interest. Diet, ADHD & Behavior: A Quarter-Century Review (2009 Update).

–  Millichap JG, Yee MM. The Diet Factor in Attention-Deficit/Hyperactivity Disorder. Pediatrics. 2012;129:330-337.

–  Natural Medicines Comprehensive Database. Natural Medicines in the Clinical Management of Attention-Deficit/Hyperactivity Disorder. Document accessed 1/7/2013.

–  Stevens LJ, Kuczek T, Burgess JR, Hurt E, Arnold LE. Dietary Sensitivities and ADHD Symptoms: Thirty-five Years of Research. Clinical Pediatrics. 2011;50(4):279-293.

–  USDHHS, NIH, Nat’l Center for Complementary and Alternative Medicine (NCCAM) website. Attention-Deficit Hyperactivity Disorder at a Glance. http://nccam.nih.gov/health/adhd/ataglance; Updated 6/19/2013. Accessed 7/10/2013.

Fall Into Flavor NOT Fads

Butternut Squash Soup

Pictured above: a Thanksgiving meal including the (top right) Roasted Butternut Squash soup and (top middle) Wild Rice and Chestnut stuffing. See recipes below. 

I’m a sucker for the fall season. All it takes is one unusual Houston cold-front in early October and I’m smitten. I pull out my boots from the back of the closet, start making hot-teas throughout the day, open all the windows in our house and at the office, and then start scouring my cookbooks for recipes that offer a soup or squash in their content! My next endeavor this fall is to use this website http://www.pickyourown.org/TXhouston.htm to find some local farms within a day-trip driving distance to go and pick my own produce which may just inspire some new recipes. Beyond new recipes, cool weather, and looking forward to some time reading a good book… something else happens about this time of year…

Just this week, I had a conversation with a colleague regarding fall weather and how it seems to elicit thoughts, memories, and cravings for delicious holiday foods and treats. When I hear people talk about this, it seems like there’s a sense of dread. Almost a statement of, “Here it comes: the ruin of any goals I had for healthy eating because _______ just tastes so good!” This makes me wonder how we have come so far in thinking that fall, winter, and holiday eating MUST be unhealthy to be enjoyable. Folks think that you have to stick to some fad diet for the entire holiday season to prevent weight gain. Wrong! The key is to focus on maintaining flavor in your food while eliminating the traditionally processed ingredients commonly found in our favorite recipes for stuffings, appetizers, desserts, soups, and stews this time of year. Don’t believe me? Try a few of the following recipes and see if their flavors are as enticing as some of those fad-diets can be.

SMOKY BUTTERNUT SQUASH SOUP

My brother-in-law made this for our Thanksgiving meal appetizer last year and it is now a family favorite. We also made this for a cooking demonstration at Heritage last holiday season and the class participants were surprised at the complex flavors of the simple ingredients.

Ingredients for 4 large (1 cup) or 8 small (1/2 cup) servings:

2 tablespoons unsalted butter

1 medium onion, finely chopped

One 3-pound butternut squash, peeled and diced (8 cups)

1 small canned chipotle in adobo, chopped

7 cups chicken or turkey stock or low-sodium broth

2 tablespoons honey

Salt

1 cup crème fraîche (or 0% plain/unflavored Greek yogurt for a lower fat version)

1/4 cup finely chopped chives, plus more for garnish

Directions:

In a large pot, melt the butter. Add the onion and cook over moderate heat until softened. Stir in the squash and chipotle and cook for 1 minute. Add the stock and honey and bring to a boil. Simmer until the squash is tender, about 30 minutes.

Puree the soup until smooth; season with salt.

In a small microwave-safe bowl, stir the crème fraîche or Greek yogurt with the 1/4 cup of chives. Microwave until just melted, 30 seconds. Serve the soup with a swirl of chive cream/yogurt and a sprinkling of chives.

SEASONED KALE CHIPS

I’m shocked at how much it costs to purchase pre-packaged kale chips at the store when they are SO easy and inexpensive to make yourself. We usually make a batch of these before dinner parties for people to snack on while the main course is being prepared. Men and women alike say they are shocked at how kale can taste so good. 

Ingredients:

  • 1 bunch organic kale, any variety
  • 1 tablespoon olive oil
  • 1 tsp. smoked paprika
  • ¼ teaspoon sea salt

Yield 8 cups

Directions:

Remove the center ribs and stems from 1 bunch kale.  Tear the leaves into 3-to-4-inch pieces. Toss with 1 tablespoon olive oil, 1 teaspoon smoked paprika and 1/4 teaspoon salt. Spread on 2 baking sheets coated with olive or canola oil cooking spray. Bake at 350 degrees F until browned around the edges and crisp, 12 to 15 minutes.

WILD RICE AND CHESTNUT STUFFING

Here is a beautiful holiday stove-top stuffing dotted with ruby-red cranberries (or cherries, depending on your preference). Good-quality wild rice triples in volume as it absorbs a rich wild mushroom broth, offering an elegant contrast to the puffy nuggets of chestnut.

To reduce prep time, you can use bottled or vacuum-packed cooked chestnuts, but truth be told, they don’t taste as good as freshly roasted.

Yield: 6-8 servings

Ingredients:

1 ounce (about 1 cup loosely packed) dried porcini or other dried mushrooms

1 cup wild rice, rinsed

30 fresh chestnuts

1 tablespoon olive oil

1 tablespoon unsalted butter

1 ½ cups chopped leeks (white and light green parts)

1 cup finely diced celery

1 to 2 tablespoons finely chopped fresh sage, plus more for garnish (or use ½ to ¾ teaspoon dried rubbed sage)

1 tablespoon dry sherry

1 tablespoon balsamic vinegar

¼ cup unsweetened dried cranberries or unsweetened dried cherries

Salt and freshly ground black pepper to taste

Soak the mushrooms in 3 ½ cups of hot water until they are soft, 15 minutes or longer. Strain and reserve the mushroom liquid. Coarsely chop any large pieces of mushrooms. Set aside.

In a heavy 2-quart Dutch oven or saucepan, bring the mushroom liquid and wild rice to a boil. Cover, reduce the heat, and cook at a gentle boil, stirring occasionally, until some of the grains have “butterflied” open and curled up, and the rice tastes tender, 45 to 65 minutes (depending upon storage conditions and age).

If you’re not using canned or bottled roasted chestnuts, while the rice is cooking, roast the chestnuts: Set a rack in the center and preheat the oven to 400 degrees F.

With the tip of a paring knife, cut an X on the flat side of each chestnut. Set, cut side up, on a rimmed baking sheet. Roast the chestnuts until the X puffs open, 20 to 25 minutes. Wrap the chestnuts in a kitchen towel for a few minutes. When they are cool enough to handle, remove the shells and use the towel to rub off the thin brown skins. Discard any chestnuts that are moldy.

Heat the oil and butter in a large, deep skillet or saucepan. Add the leeks, celery, and dried sage (if using) and cook over low heat, stirring occasionally, until the vegetables are soft, 15 to 20 minutes. Stir in the sherry, balsamic vinegar, and cranberries, and cook uncovered for a few minutes. Stir in the chestnuts and soak mushrooms. Cover and set aside until the rice is done.

Stir the rice (including any unabsorbed cooking liquid) and fresh sage (if using) to taste into the leek mixture. Season with salt and pepper. Cover and simmer until the celery and leeks are tender and the flavors have mingled, about 5 minutes. Add a little water during this time if the mixture becomes dry. Garnish with additional sage, if using fresh.