Most doctors will not recommend dietary adjustments for ADHD, and most have never tried them. Should clinicians and families pay any attention to the growing body of research suggesting dietary methods in treating ADHD?
Omega-3 fatty acid supplementation (FAS), additive-free and elimination diets, and the roles of zinc, iron and sugar have all been studied in ADHD, and some of the research is discussed in an article published today in Pediatrics. J. Gordon Millichap, M.D., and Michelle M. Yee, C.P.N.P., present a review of recent studies and controlled trials, covering a variety of dietary factors and suggesting foods to avoid and foods preferred in ADHD.
Omega-3 and -6 fatty acid supplementation:
Some studies describe abnormal levels of essential fatty acids in subjects with ADHD. The review authors mention a controlled trial that found decreased ADHD scores in a group taking omega-3 fatty acids compared to a group taking placebo, and say that others fail to show a beneficial response. They wrote:
On the basis of reports of efﬁcacy and safety, we use doses of 300 to 600 mg/day of omega-3 and 30 to 60 mg/day of omega-6 FAS, continued for 2 or 3 months, or longer if indicated.
Additive-free and elimination diets:
The authors say that an “occasional child” might react adversely to dyes and preservatives in foods. They describe elimination diets and testing for food sensitivities as “too burdensome”, likely benefiting only a small subset of those with ADHD.
Sugar fluctuations and aspartame:
Some studies conclude that sugar or aspartame do not have adverse effects on behavior or cognition in children. The reviewers offer reactive hypoglycemia as possibly having an effect on cognition in children. They suggest that avoiding rapidly absorbed sucrose-containing foods in young children may prevent some diet-related problems of ADHD.
Foods to avoid and foods preferred in ADHD:
The authors wrote:
The Western dietary pattern associated with an ADHD diagnosis contains higher intakes of total fat, saturated fat, reﬁned sugars, and sodium and is deﬁcient in omega-3 fatty acids, ﬁber, and folate. The Healthy diet pattern, not associated with ADHD diagnosis, is rich in ﬁsh, vegetables, fruit, legumes, and whole-grain foods.
The indications for diet therapy include the following: (1) medication failure or adverse reaction, (2) parent or patient preference, (3) symptoms or signs of mineral deﬁciency, and (4) the need to substitute an ADHD-free healthy diet for an ADHD-linked diet. Diet is one environmental etiology of ADHD that is amenable to modiﬁcation.
The differences between those eating the aforementioned ‘Western’ and ‘Healthy’ diets may be confounded by parenting and other environmental factors, but I can’t help but wonder if there aren’t some real links between dietary factors and ADHD. There is little doubt about the increasing incidence of peanut, and other, allergies in children. If more dietary factors are causing physiological phenomena like anaphylaxis, could an increasing number of dietary factors have an effect on behavior, emotion or cognition?
Sandy Newmark, M.D., is the head of the Pediatric Integrative Neurodevelopmental Program at the Osher Center for Integrative Medicine, specializing in the treatment of Autism, ADHD and other developmental or chronic childhood conditions. He told me that he thinks the review includes good information but wonders why they didn’t mention a recent meta-analysis which concluded that omega-3 fatty acid supplementation was beneficial in ADHD. He added:
They also make a big deal about how difficult elimination diets are for the family, but for many families the improvement in symptoms without the side-effects of medication makes this quite worthwhile.