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

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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