Are Attention-Deficit/Hyperactivity Disorder Symptoms Affected By Diet?

Written by Dr. Steve Chaney on . Posted in ADHD Diet, ADHD Symptoms

What Can You Do To Reduce ADHD Symptoms In Your Child?

Author: Dr. Stephen Chaney

 

attention deficit hyperactivity disorderAttention-Deficit/Hyperactivity Disorder rates for American children are skyrocketing. One study reported that the percentage of children diagnosed with ADHD has increased by 43% between 2003 and 2011. Another study reported an increase of 67% between 1997 and 2015. Currently, 10-12% of American schoolchildren are diagnosed with ADHD. That amounts to around 6 million children with Attention-Deficit/Hyperactivity Disorder.

The reason for the rapid increase in ADHD symptoms is controversial.

  • Some experts claim the increase simply reflects more accurate diagnostic protocols.
  • Others say the increase is driven by aggressive marketing of ADHD drugs by pharmaceutical companies.
  • Others feel the cause is environmental, with the worsening American diet and increased exposure to toxins in everyday consumer products being named as the most likely culprits.

Attention-Deficit/Hyperactivity Disorder Side Effects

 

62% of children diagnosed with Attention-Deficit/Hyperactivity Disorder are taking ADHD medications. These medicines reduce, but do not eliminate, ADHD symptoms. But the improvements come at a high price. Side effects include:

  • Sleeping problems.
  • Reduced taste perception.
  • Loss of appetite.
  • Anxiety, moodiness, and irritability.
  • Headaches and stomachaches.

Because of the side effects of ADHD medicines, parents often look for more natural solutions. Many of them report that improving their child’s diet reduces their child’s ADHD symptoms as well or better than ADHD medications. Are their opinions accurate, or do the child’s ADHD symptoms improve just because their parents are paying more attention to them?

The latest headlines proclaim that improving a child’s diet does not reduce their ADHD symptoms. Are those headlines correct, or do parents know something that the scientists missed?

To answer those questions, we should start by looking at the study (https://doi.org/10.1093/jn/nxy273) behind the headlines.

 

How Was The Study Done?

 

attention deficit hyperactivity disorder studyThe authors of this study analyzed data from 3680 children who were involved in the Generation R Study in Rotterdam, Netherlands. This study measured the association between Attention-Deficit/Hyperactivity Disorder symptoms and diet quality.

However, this was not a simple association study. It was something called a prospective cohort study. That means rather than measuring the association at a single time like most studies, this study measured ADHD symptoms at age 6 and 10 and diet quality at age 8.

Attention-Deficit/Hyperactivity Disorder symptoms were assessed by using parent-reported questionnaires. Dietary intake was assessed by using a validated food frequency questionnaire filled out by the parents. Diet quality was based on comparing a child’s dietary intake to the Dutch dietary recommendations for children (Which are not significantly different from the US dietary recommendations).

 

Are Attention-Deficit/Hyperactivity Disorder Symptoms Affected By Diet?

 

The results of the study were confusing:

  • ADHD symptoms at age 6 were associated with poorer diet quality at age 8.
  • However, there was no association between diet quality at age 8 and ADHD symptoms at age 10.

The author’s conclusions, which generated the headlines you may have seen, were even more confusing.

Based on the first finding (Attention-Deficit/Hyperactivity Disorder symptoms at age 6 associated with poorer diet quality at age 8), they concluded “…children with more ADHD symptoms may be at a higher risk of an unhealthy diet.” They hypothesized:

  • ADHD symptoms may cause “…impulsive eating of highly palatable foods or no patience to eat vegetables…”
  • “…parents try to soothe difficult behavior of their children by offering meals, snacks, and beverages children prefer instead of healthy choices.”

Based on the second finding (diet quality at age 8 having no relationship with ADHD symptoms at age 10), they concluded “…overall diet quality does not affect ADHD risk.”

In short, they concluded that Attention-Deficit/Hyperactivity Disorder caused poor diets, but poor diets did not cause ADHD.

 

Are The Conclusions Of This Study Accurate?

attention deficit hyperactivity disorder thumbs downThe authors identified several important limitations of their study. For example, they acknowledged:

  • They relied on parent reporting of both ADHD symptoms and dietary intake.
    • Parents may have found it difficult to assess ADHD behavior in their children.
    • Parents may not have known what their children consumed at school or during after-school care.
  • Both dietary intake and ADHD symptoms may change over time.
    • ADHD symptoms are different at age 6 and 10, so two different ADHD assessment questionnaires were used.
    • Parents have less control (and knowledge) of their child’s diet at age 10 than at age 8. The dietary assessment at age 8 might not have been valid for the children two years later.

However, to me the two biggest weakness of the study were:

  • All the children in the study had ADHD symptoms at both ages 6 and 10. These were the same children! That makes the fact that ADHD symptoms correlated with diet quality at age 6, but not at age 10 highly suspect.
  • ADHD symptoms and diet quality were measured at different times. This is a bizarre experimental design. The study would have been much stronger if the authors had measured both diet quality and ADHD symptoms at each age.

In short, this study is fatally flawed. The conclusions of the study are inaccurate. You should ignore the headlines.

 

What Can You Do To Reduce Attention-Deficit/Hyperactivity Disorder Symptoms In Your Child?

 

attention deficit hyperactivity disorder questionThe recent study does illustrate the difficulty in proving diet-ADHD interactions. The truth is ADHD is a complex condition. It is affected by genetics, environment, family interactions, and food. This is best illustrated by a review written by two pediatricians specializing in ADHD that I featured in ADHD Diet vs Medication of “Health Tips From The Professor.”

The authors of the review described multiple nutritional approaches that reduce ADHD symptoms. The catch was each nutritional intervention only worked for some children. Parents needed to be willing to find what works best for their child by trial and error. Let me give some examples.

  • Eliminating Food Additives: The idea that food additives cause ADHD symptoms originated with the Feingold diet which was popularized in the 1970s. The Feingold diet eliminated food additives, foods with salicylates (luncheon meats, sausage, hot dogs), drinks containing artificial colors and flavors, and chemical preservatives (e.g. BHA and BHT). After clinical studies showed that only 6% percentage of children benefitted from this diet, it fell out of favor.

However, the experts who pooh-poohed the diet missed a key point. Yes, 6% is a very small percentage of the general population. However, if you are one of those parents whose child is in the 6%, this approach works wonders. A recent study showed that when children with suspected sensitivity to food additives were challenged with food colors, 65-89% of them displayed ADHD sensitivities.

My recommendation: Food additives are not one of the five essential food groups. There is no reason not to eliminate food additives from your child’s diet, and it might make a world of difference for their ADHD symptoms.

  • Adding Omega-3 Fatty Acids: The authors of the review reported that several studies have shown children with ADHD tend to have low levels of omega-3 fatty acids. They also cited several studies which showed significant improvement in reading skills and reductions in ADHD symptoms when children with ADHD were give omega-3 supplements. It was usually the children with the lowest omega-3 status who showed the biggest improvement in ADHD symptoms.

attention deficit hyperactivity disorder symptomsThe pediatricians who wrote the review routinely use doses of 300-600 mg of omega-3s with their ADHD patients. They find that this intervention reduces ADHD symptoms in many children but does not completely eliminate the need for medications.

My recommendation: Whether adding omega-3s will help your child is anyone’s guess. However, it is a natural approach with no side effects. It is definitely worth trying.

  • Adding Iron and Zinc: Some studies have suggested that iron and zinc deficiencies may be associated with ADHD symptoms.

My recommendation: A good children’s multivitamin should be sufficient to eliminate these deficiencies.

  • Eliminating Sugar: This recommendation is controversial, but the authors of the review said it helps some of the children they treat reduce their ADHD symptoms.

My recommendation: Reducing intake of refined sugars in your child’s diet makes sense for many reasons, especially considering the role of sugar intake in obesity. If it also reduces ADHD symptoms, that is an added benefit.

  • Eating A Healthy Diet: Several studies have shown that children eating “Healthy” diets (fish, chicken, vegetables, fresh fruit, whole grains & low fat dairy products) have fewer ADHD symptoms than children eating “Western” diets (Fast foods, red meat, processed meats, processed snacks, high fat dairy products & soft drinks).

My recommendation: Again, this is an approach that makes sense for many reasons. If you and your family were to follow a “Healthy” diet instead of a “Western” diet, it would likely have numerous health benefits. Plus, you would automatically remove ADHD triggers such as food additives and sugar from your child’s diet.

  • Eliminating Food Sensitivities: If you have tried everything and your child’s ADHD symptoms are as bad as ever, your child may have a sensitivity to a perfectly healthy food. Even natural foods can be a problem for children with food sensitivities, and it appears that there may be a large percentage of hyperactive children with food sensitivities. The authors of the review reported that elimination diets (diets that eliminate all foods which could cause food sensitivity) improve behavior in 76-82% of hyperactive children.

Even though this approach can be very effective they don’t normally recommend it for their patients because it is difficult and time-consuming. The elimination diet is very restrictive and needs to be followed for a few weeks. Then individual foods need to be added back one at a time until the offending food(s) are identified. (They also reported that antigen testing is not a particularly effective way of identifying food sensitivities associated with hyperactivity).

My recommendation: I view this as something to be tried after all other natural approaches have failed. However, if there is a particular food that causes hyperactivity in your child, identifying it and eliminating it from their diet could be something that would benefit them for the rest of their life.

 

The Bottom Line

 

You may have seen recent headlines suggesting that healthy diets do not reduce ADHD symptoms. In fact, the study behind the headlines concluded that ADHD may cause poor diets, but poor diets do not cause ADHD.

My mission in writing “Health Tips From the Professor” is to analyze the studies behind the headlines and tell you whether you can believe the headlines or not.

In this case my analysis is clear-cut.

  • The study is fatally flawed.
  • Its conclusions are inaccurate.
  • You can forget the headlines.

However, the study does illustrate the difficulty in proving diet-ADHD interactions. The truth is ADHD is a complex condition. It is affected by genetics, environment, family interactions, and food.

There are multiple nutritional approaches that reduce ADHD symptoms. The catch is each nutritional intervention only works for some children. Parents need to be willing to find what works best for their child by trial and error. Here are some of the nutritional approaches that have merit:

  • Eliminate food additives.
  • Add omega-3s.
  • Add a children’s multivitamin.
  • Eliminate added sugars.
  • Eat a healthy diet.
  • Eliminate food sensitivities.

For more details read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Latest Article

Omega-3 Benefits: Lower High Blood Pressure

Posted July 16, 2019 by Dr. Steve Chaney

What Does the FDA Say About Omega-3 Benefit Claims?

Author: Dr. Stephen Chaney

 

 

Among omega-3 benefits is lower high blood pressure.  That claim can be made according to the FDA. 

lower high blood pressureHeart Disease is still the number 1 cause of death in this country. And, while deaths from heart disease have been declining in recent years, deaths due to high blood pressure have been increasing.  That is concerning because:

High blood pressure is a killer! It can kill you by causing heart attacks, strokes, congestive heart failure, kidney failure and much more.

High blood pressure is a serial killer. It doesn’t just kill a few people. It kills lots of people. The American Heart Association estimates that high blood pressure directly or indirectly caused 410,000 deaths in 2014. That is almost 1 person every second and represents a 41% increase from 2000. It’s because high blood pressure is not a rare disease.

  • 32% of Americans have high blood pressure, also called hypertension, (defined as a systolic blood pressure of 140 mm Hg or more or a diastolic blood pressure of 90 mm Hg or more).
  • Another 33% of Americans have prehypertension (systolic blood pressure of 120-139 mm Hg or diastolic blood pressure of 80-89 mm Hg).

That’s over 65% of Americans with abnormal blood pressure!

High blood pressure is a silent killer. That’s because it is a very insidious disease that sneaks up on you when you least expect it. Systolic blood pressure increases 0.6 mm Hg/year for most adults over 50. By age 75 or above 76-80% of American adults will have high blood pressure.  Even worse, many people with high blood pressure have no symptoms, so they don’t even know that their blood pressure is elevated. For them the first symptom of high blood pressure is often sudden death.

Blood pressure medications can harm your quality of life. Blood pressure medications save lives. However, like most drugs, blood pressure medications have a plethora of side effects – including weakness, dizziness, fainting, shortness of breath, chest pain, nausea, diarrhea or constipation, heartburn, depression, heart palpitations, and even memory loss. The many side effects associated with blood pressure medications lead to poor compliance, which is probably why only 46% of patients with high blood pressure are adequately controlled.

You do have natural options. By now you are probably wondering whether there are natural approaches for controlling your blood pressure that are both effective and lack side effects. The answer is a resounding YES! I’ll outline a holistic natural approach for keeping your blood pressure under control in a minute but let me start with the FDAs recent approval of what they call “qualified claims” that omega-3s lower blood pressure.

 

What Does the FDA Say About Omega-3 Benefits?

omega-3 benefitsIn my book “Slaying The Supplement Myths” I talk about the “dark side” of the supplement industry. There are far too many companies who try to dupe the public by making outrageous and unsubstantiated claims about their products.

Only the FDA stands between us and those unscrupulous companies, and they take their role very seriously. That is why it is big news whenever the FDA allows companies to make health claims about their products.

Even then, the FDA is very cautious. They allow what they call “qualified” health claims. Basically, that means they are saying there is enough evidence that the health claim is probably true, but not enough evidence to say it is proven.

Of course, if you understand the scientific method, you realize there will always be some studies on both sides of every issue. That is why the only health claims the FDA allows are qualified health claims.

With that background in mind, let’s look at the qualified health claims the FDA allows for omega-3 benefits.

  • Since 2004 the FDA has allowed the qualified claim “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”
  • A few weeks ago, they added five qualified health claims about omega-3s and blood pressure. The 5 claims are very similar, so I will only list two below for the sake of brevity.
  • “Consuming EPA and DHA combined may reduce blood pressure and reduce the risk of hypertension, a risk factor for CHD (coronary heart disease).”
  • Consuming EPA and DHA combined may reduce the risk of CHD (coronary heart disease) by lowering blood pressure.
  • Of course, they add the usual wording about the evidence being inconsistent and inconclusive.

 

Omega-3 Benefits?

measure omega-3 benefits levelWe’ve known for some time that omega-3 fatty acids help lower blood pressure, but two recent studies were instrumental in convincing the FDA to allow these qualified health claims. These studies have highlighted just how strong the effect of omega-3s on lowering blood pressure is.

The first study was a meta-analysis of 70 randomized, placebo-controlled clinical trials of long chain omega-3 (EPA + DHA) supplementation and blood pressure (Miller et al, American Journal of Hypertension, 27: 885-896, 2014 ).

This study showed:

  • In the group with normal blood pressure at the beginning of the study EPA + DHA supplementation decreased systolic blood pressure by 1.25 mm Hg.
  • Given that systolic blood pressure rises an average of 0.6 mm Hg/year in adults over 50, the authors estimated that omega-3 supplementation alone would delay the onset of age-related high blood pressure by 2 years.
  • In the group with elevated blood pressure not taking medication at the beginning of the study, EPA + DHA supplementation decreased systolic blood pressure by an impressive 4.51 mm Hg and diastolic blood pressure by 3.05 mm Hg.
  • The authors noted that this decrease in systolic blood pressure could “prevent an individual from requiring medication [with all its side effects] to control their hypertension” or decrease the amount of medication required.

However, the doses of omega-3s used in these studies ranged from 1 to over 4 grams/day (mean dose = 3.8 grams/day). That sparked a second study (Minihane et al, Journal of Nutrition, 146: 516-523, 2016) to see whether lower levels of omega-3s might be equally effective. This study was an 8-week double-blind, placebo-controlled study comparing the effects of 0.7 or 1.8 grams of EPA + DHA per day (versus an 8:2 ratio of palm and soybean oil as a placebo) on blood pressure.

This study showed:

  • In the group with normal blood pressure at the beginning of the study, EPA + DHA supplementation caused no significant decrease in blood pressure. This could be due to the smaller number of subjects or the lower doses of EPA + DHA used in this study.
  • In the group with elevated blood pressure not taking medication at the beginning of the study, EPA + DHA supplementation decreased systolic blood pressure by 5 mm Hg and, the effect was essentially identical at 0.7 grams/day and 1.8 grams/day.
  • The authors concluded “Our data suggest that increased EPA + DHA intakes of only 0.7 grams/day may be an effective strategy for blood pressure control.”

 

A Holistic Approach to Lower High Blood Pressure

holistic approach to lower high blood pressureThe FDA’s allowed claims about omega-3s are good news indeed, but that’s not the only natural approach that lowers blood pressure. You have lots of other arrows in your quiver. For example:

  • The DASH diet (A diet that has lots of fresh fruits and vegetables; includes whole grains, low fat dairy, poultry, fish, beans, nuts and oils; and is low in sugar and red meats) reduces systolic blood pressure by 5-6 mm Hg. [Low fat, low carb and Mediterranean diets also lower blood pressure, but not by as much as the DASH diet].
  • Reducing sodium by about 1,150 mg/day reduces systolic blood pressure by 3-4 mm Hg.
  • Reducing excess weight by 5% reduces systolic blood pressure by 3 points.
  • Doing at least 40 minutes of aerobic exercise 3-4 times/week reduces systolic blood pressure by 2-5 mm Hg.
  • Nitrates, whether derived from fresh fruits and vegetables or from supplements probably also reduce blood pressure, but we don’t yet know by how much.

If you’ve been keeping track, you’ve probably figured out that a holistic lifestyle that included at least 0.7 grams/day of long chain omega-3s (EPA + DHA) plus the other omega-3 benefits in the list above could reduce your systolic blood pressure by a whopping 18-22 mm Hg.  What

That’s significant because, the CDC estimates that reducing high systolic blood pressure by only 12-13 mm Hg could reduce your risk of:

  • Stroke by 37%.
  • Coronary heart disease by 21%.
  • Death from cardiovascular disease by 25%.
  • Death from all causes by 13%.

 

A Word of Caution

While holistic approaches have the potential to keep your blood pressure under control without the side effects of medications, it is important not to blindly rely on holistic approaches alone. There are also genetic and environmental risk factors involved in determining blood pressure. You could be doing everything right and still have high blood pressure. Plus, you need to remember that high blood pressure is a silent killer that often doesn’t have any detectable symptoms prior to that first heart attack or stroke.

My recommendations are:

  • Monitor your blood pressure on a regular basis.
  • If your blood pressure starts to become elevated, consult with your doctor about starting with natural approaches to bring your blood pressure back under control. Doctors are fully aware of the side effects of blood pressure medications, and most doctors are happy to encourage you to try natural approaches first.
  • Continue to monitor blood pressure as directed by your doctor. If natural approaches are insufficient to bring your blood pressure under control, they will prescribe the lowest dose of blood pressure medication possible to get your blood pressure where it needs to be.
  • Don’t stop making holistic lifestyle choices to reduce blood pressure just because you are on medication. The more you do to keep your blood pressure under control with a healthy diet and lifestyle, the less medication your doctor will need to use (That means fewer side effects).

 

The Bottom Line

Heart Disease is still the number 1 cause of death in this country. And, while deaths from heart disease have been declining in recent years, deaths due to high blood pressure have been increasing. That is why anything we can do lower blood pressure naturally is important. What does the FDA say about omega-3s and blood pressure?

  • Since 2004 the FDA has allowed the qualified claim “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”
  • A few weeks ago, they added qualified health claims about omega-3s and blood pressure. For example, they now allow the following claims.
  • “Consuming EPA and DHA combined may reduce blood pressure and reduce the risk of hypertension, a risk factor for CHD (coronary heart disease).”
  • Consuming EPA and DHA combined may reduce the risk of CHD (coronary heart disease) by lowering blood pressure.

For more information on the studies that convinced the FDA to allow claims about omega-3s and blood pressure and for a discussion of holistic natural approaches for lowering blood pressure, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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