What Causes ADHD?

Written by Dr. Steve Chaney on . Posted in Food and Health

Do Foods Make Kids Fidget?

Author: Dr. Stephen Chaney

 

what causes adhd in kidsWhen I was a kid we didn’t have all of these fancy words like hyperactivity, ADD and ADHD. If a kid had trouble sitting still and trouble focusing on the task at hand, they were just considered “fidgety”.  So, what causes ADHD in kids?

Now that I’ve dated myself once again, let’s get to the real topic which is: “Can the foods that your kids eat have any relationship to ADD and ADHD symptoms?”

To put things into perspective, the CDC just announced that 11% of all school age children in the US have been diagnosed with ADHD. That is a 41% increase in the last decade alone. I am not going to discuss the controversy about why the incidence of ADHD is rising so rapidly in this country. That is another story for another time.

My concern is that two thirds of those children are being given stimulant medications like Ritalin and Adderall. While those medications can help reduce the symptoms, they can also cause serious side effects such as addiction, anxiety and psychosis.

So it might be time to stop and ask, is there a better way? Could the foods those children are eating cause ADHD? If so, could something as simple as changing their diet control the symptoms of ADHD without any side effects?

I’ve talked about the effect of food additives, Do Artificial Colors Cause Hyperactivity  , and the sugar content of the diet on hyperactivity in previous issues of my “Health Tips from the Professor”.

The question that I’m posing today is whether sensitivities to foods that we would otherwise consider to be healthy could also trigger ADHD symptoms?

Could The Foods Our Children Eat Cause ADHD?

Could food be what causes ADHD in kids?  Many clinicians have long felt that food sensitivities could be associated with ADHD symptoms because many of the children that they were treating for ADHD also had food sensitivities that showed up as eczema, asthma and gastrointestinal problems. But no definitive clinical studies had been performed in this area, so the idea that food sensitivities might cause ADHD symptoms remained an open question.

However, a major clinical study called The Impact of Nutrition on Children with ADHD was recently performed that suggests the answer to this question is a resounding YES – food sensitivities can cause ADHD symptoms (Pelesser et al, Lancet, 377: 494-503, 2011).

100 children from the Netherlands and Belgium with a definitive diagnosis of ADHD were enrolled in the study. The age of the children was 4 to 8 years old because it is easiest to control the food intake of children in that age group.

At the beginning of the study every child was given IgG blood tests to identify food sensitivities. During the first 5 weeks of the program the children were divided into two groups.

  • can foods cause adhd in kidsOne group was put on a restricted elimination diet consisting of rice, meats, vegetables, pears and water for 5 weeks (An elimination diet is the “gold standard” for evaluating food sensitivities because it eliminates almost every food known to cause sensitivity from the diet).
  • The second group was put on a “healthy diet” – one which met current nutritional guidelines, but did not eliminate any food or food group from the diet.

At the end of this 5-week period all of the children were evaluated for ADHD symptoms in a blinded fashion by a pediatrician specializing in diagnosing and treating ADHD.

  • An astonishing 78% of the children on the elimination diet had a reduction in their ADHD symptoms!
  • Those on the “healthy diet” showed no significant improvement in symptoms.

Can IgG Tests Identify Children Who Will Benefit From Changing Their Diet?

The first phase of the study (described above) was followed by a second phase in which restricted foods were added back to the diet of those children who had responded positively to the elimination diet.

But the foods were not added back randomly. Each child was exposed for two weeks to foods with a high IgG response in their initial screen and for two weeks to foods with a low IgG response in their initial screen. In others words the foods added back were different for each child and were based on their individual IgG results.

This phase of the trial was done in a crossover fashion – meaning that half of the children received low IgG foods during the first two weeks followed by high IgG foods during the second two weeks – and for the other half of the children the order was reversed.

And this phase of the study was also done in a double blind fashion – meaning that neither the children nor the evaluators knew whether they were receiving low IgG foods or high IgG foods during the test period.

The results of this phase of the study were also very interesting:

  • There was a substantial worsening of ADHD symptoms in 63% of the children when restricted foods were added back to the diet
  • AND – it didn’t matter whether the foods were low IgG foods or high IgG foods.

The authors’ conclusions were simple:

  • Food sensitivities make a substantial contribution to ADHD symptoms in children.
  • Don’t waste your money on the IgG tests (They have been controversial for some time).

 

The Bottom Line

What is the significance of this study if you have a child with ADHD? According to a recent study:

  • Food sensitivities make a substantial contribution to ADHD symptoms in children.
  • Don’t waste your money on the IgG tests (They have been controversial for some time).
  • The best way to see if foods trigger your child’s ADHD symptoms is to put them on an elimination diet, and if they show an improvement on the elimination diet, add the restricted foods back one or two at a time so you can identify the ones that should be avoided in the future.

Some of you might be saying that sounds difficult (it is), so why bother?

  • The answer is that 11% of school age children in this country are diagnosed with ADD or ADHD – and almost all of them are treated with drugs that can have serious side effects.
  • Using an elimination diet to find out whether your child’s ADHD is triggered by food sensitivities and then changing their diet has absolutely no side effects!

Some of you might be asking, “Are there any easier drug-free approaches that one could try, or is there any natural approach that might work for the 22% of children who don’t respond to the elimination diet?”

The answer to both questions is yes.

  • Simply eliminating food additives, junk foods and/or sugary foods from the diet helps reduce ADHD symptoms in many children.
  • You also shouldn’t neglect the role that supplementation can play in laying a strong nutritional foundation for your child. I recommend a good children’s multivitamin to make sure that they are getting the nutrients they need, a protein supplement to help prevent blood sugar swings, a good omega-3 (preferably DHA) supplement to support brain health and a supplemental source of friendly bacteria to promote gut health.

But if all else fails I would recommend trying an elimination diet to identify problem foods and then eliminating those foods from your child’s diet before putting them on drugs.

 

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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Comments (2)

  • Art Bikssonnette

    |

    Steve, I’ve lost your recent article on Lies Food Stores tell. May I have a copy. You are really doing so much to help us

    Reply

    • Dr. Steve Chaney

      |

      Dear Art,

      All of my “Health Tips” are archived. Just go to https://www.healthtipsfromtheprofessor.com and type the appropriate term into the search box. In this case either “lies” or “food label” should do it.

      Reply

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Latest Article

A Low Carb Diet and Weight Loss

Posted January 15, 2019 by Dr. Steve Chaney

Do Low-Carb Diets Help Maintain Weight Loss?

Author: Dr. Stephen Chaney

 

low carb dietTraditional diets have been based on counting calories, but are all calories equal? Low-carb enthusiasts have long claimed that diets high in sugar and refined carbs cause obesity. Their hypothesis is based on the fact that high blood sugar levels cause a spike in insulin levels, and insulin promotes fat storage.

The problem is that there has been scant evidence to support that hypothesis. In fact, a recent meta-analysis of 32 published clinical studies (KD Hall and J Guo, Gastroenterology, 152: 1718-1727, 2017 ) concluded that low-fat diets resulted in a higher metabolic rate and greater fat loss than isocaloric low-carbohydrate diets.

However, low-carb enthusiasts persisted. They argued that the studies included in the meta-analysis were too short to adequately measure the metabolic effects of a low-carb diet. Recently, a study has been published in the British Medical Journal (CB Ebbeling et al, BMJ 2018, 363:k4583 ) that appears to vindicate their position.

Are low carb diets best for long term weight loss?

Low-carb enthusiasts claim the study conclusively shows that low-carb diets are best for losing weight and for keeping it off once you have lost it. They are saying that it is time to shift away from counting calories and from promoting low-fat diets and focus on low-carb diets instead if we wish to solve the obesity epidemic. In this article I will focus on three issues:

  • How good was the study?
  • What were its limitations?
  • Are the claims justified?

 

How Was The Study Designed?

low carb diet studyThe investigators started with 234 overweight adults (30% male, 78% white, average age 40, BMI 32) recruited from the campus of Framingham State University in Massachusetts. All participants were put on a diet that restricted calories to 60% of estimated needs for 10 weeks. The diet consisted of 45% of calories from carbohydrate, 30% from fat, and 25% from protein. [So much for the claim that the study showed low-carb diets were more effective for weight loss. The diet used for the weight loss portion of the diet was not low-carb.]

During the initial phase of the study 161 of the participants achieved 10% weight loss. These participants were randomly divided into 3 groups for the weight maintenance phase of the study.

  • The diet composition of the high-carb group was 60% carbohydrate, 20% fat, and 20% protein.
  • The diet composition of the moderate-carb group was 40% carbohydrate, 40% fat, and 20% protein.
  • The diet composition of the low-carb group was 20% carbohydrate, 60% fat, and 20% protein.

Other important characteristics of the study were:

  • The weight maintenance portion of the study lasted 5 months – much longer than any previous study.
  • All meals were designed by dietitians and prepared by a commercial food service. The meals were either served in a cafeteria or packaged to be taken home by the participants.
  • The caloric content of the meals was individually adjusted on a weekly basis so that weight was kept within a ± 4-pound range during the 5-month maintenance phase.
  • Sugar, saturated fat, and sodium were limited and kept relatively constant among the 3 diets.

120 participants made it through the 5-month maintenance phase.

 

Do Low-Carb Diets Help Maintain Weight Loss?

low carb diet maintain weight lossThe results were striking:

  • The low-carb group burned an additional 278 calories/day compared to the high-carb group and 131 calories/day more than the moderate-carbohydrate group.
  • These differences were even higher for those individuals with higher insulin secretion at the beginning of the maintenance phase of the study.
  • These differences lead the authors to hypothesize that low-carb diets might be more effective for weight maintenance than other diets.

 

What Are The Pros And Cons Of This Study?

low carb diet pros and consThis was a very well-done study. In fact, it is the most ambitious and well-controlled study of its kind. However, like any other clinical study, it has its limitations. It also needs to be repeated.

The pros of the study are obvious. It was a long study and the dietary intake of the participants was tightly controlled.

As for cons, here are the three limitations of the study listed by the authors:

#1: Potential Measurement Error: This section of the paper was a highly technical consideration of the method used to measure energy expenditure. Suffice it to say that the method they used to measure calories burned per day may overestimate calories burned in the low-carb group. That, of course, would invalidate the major findings of the study. It is unlikely, but it is why the study needs to be repeated using a different measure of energy expenditure.

#2: Compliance: Although the participants were provided with all their meals, there was no way of being sure they ate them. There was also no way of knowing whether they may have eaten other foods in addition to the food they were provided. Again, this is unlikely, but cannot be eliminated from consideration.

#3: Generalizability: This is simply an acknowledgement that the greatest strength of this study is also its greatest weakness. The authors acknowledged that their study was conducted in such a tightly controlled manner it is difficult to translate their findings to the real world. For example:

  • Sugar and saturated fat were restricted and were at very similar levels in all 3 diets. In the real world, people consuming a high-carb diet are likely to consume more sugar than people in the other diet groups. Similarly, people consuming the low-carb diet are likely to consume more saturated fat than people in the other diet groups.
  • Weight was kept constant in the weight maintenance phase by constantly adjusting caloric intake. Unfortunately, this seldom happens in the real world. Most people gain weight once they go off their diet – and this is just as true with low-carb diets as with other diets.
  • The participants had access to dietitian-designed prepared meals 3 times a day for 5 months. This almost never happens in the real world. The authors said “…these results [their data] must be reconciled with the long-term weight loss trials relying on nutrition education and behavioral counseling that find only a small advantage for low carbohydrate compared with low fat diets according to several recent meta-analyses.” [I would add that in the real world, people do not even have access to nutritional education and behavioral modification.]

 

low carb diet and youWhat Does This Study Mean For You?

  • This study shows that under very tightly controlled conditions (dietitian-prepared meals, sugar and saturated fat limited to healthy levels, calories continually adjusted so that weight remains constant) a low-carb diet burns more calories per day than a moderate-carb or high-carb diet. These findings show that it is theoretically possible to increase your metabolic weight and successfully maintain a healthy weight on a low-carb diet. These are the headlines you probably saw. However, a careful reading of the study provides a much more nuanced viewpoint. For example, the fact that the study conditions were so tightly controlled makes it difficult to translate these findings to the real world.
  • In fact, the authors of the study acknowledged that multiple clinical studies show this almost never happens in the real world. These studies show that most people regain the weight they have lost on low-carb diets. More importantly, the rate of weight regain is virtually identical on low-carb and low-fat diets. Consequently, the authors of the current study concluded “…translation [of their results to the real world] requires exploration in future mechanistic oriented research.” Simply put, the authors are saying that more research is needed to provide a mechanistic explanation for this discrepancy before one can make recommendations that are relevant to weight loss and weight maintenance in the real world.
  • The authors also discussed the results of their study in light of a recent, well-designed 12-month study (CD Gardener et al, JAMA, 319: 667-669, 2018 ) that showed no difference in weight change between a healthy low-fat versus a healthy low-carbohydrate diet. That study also reported that the results were unaffected by insulin secretion at baseline. The authors of the current study noted that “…[in the previous study] participants were instructed to minimize or eliminate refined grains and added sugars and maximize intake of vegetables. Probably for this reason, the reported glycemic load [effect of the diet on blood sugar levels] of the low-fat diet was very low…and similar to [the low-carb diet].” In short, the authors of the current study were acknowledging that diets which focus on healthy, plant-based carbohydrates and eliminate sugar, refined grains, and processed foods may be as effective as low-carb diets for helping maintain a healthy weight.
  • This would also be consistent with previous studies showing that primarily plant-based, low-carb diets are more effective at maintaining a healthy weight and better health outcomes long-term than the typical American version of the low-fat diet, which is high in sugar and refined grains. In contrast, meat-based, low-carb diets are no more effective than the American version of the low-fat diet at preventing weight gain and poor health outcomes. I have covered these studies in detail in my book “Slaying The Food Myths.”

Consequently, the lead author of the most recent study has said: “The findings [of this study] do not impugn whole fruits, beans and other unprocessed carbohydrates. Rather, the study suggests that reducing foods with added sugar, flour, and other refined carbohydrates could help people maintain weight loss….” This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.

The Bottom Line

 

  • A recent study compared the calories burned per day on a low-carb, moderate-carb, and high-carb diet. The study concluded that the low-carb diet burned significantly more calories per day than the other two diets and might be suitable for long-term weight control. If confirmed by subsequent studies, this would be the first real evidence that low-carb diets are superior for maintaining a healthy weight.
  • However, the study has some major limitations. For example, it used a methodology that may overestimate the benefits of a low-carb diet, and it was performed under tightly controlled conditions that can never be duplicated in the real world. As acknowledged by the authors, this study is also contradicted by multiple previous studies. Further studies will be required to confirm the results of this study and show how it can be applied in the real world.
  • In addition, the kind of carbohydrate in the diet is every bit as important as the amount of carbohydrate. The authors acknowledge that the differences seen in their study apply mainly to carbohydrates from sugar, refined grains, and processed foods. They advocate diets with low glycemic load (small effects on blood sugar and insulin levels) and acknowledge this can also be achieved by incorporating low-glycemic load, plant-based carbohydrates into your diet. This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.
  • Finally, clinical studies report averages, but none of us are average. When you examine the data from the current study, it is evident that some participants burned more calories per hour on the high-carb diet than other participants did on the low carb diet. That reinforces the observation that some people lose weight more effectively on low-carb diets while others lose weight more effectively on low-fat diets. If you are someone who does better on a low-carb diet, the best available evidence suggests you will have better long-term health outcomes on a primarily plant-based, low-carb diet such as the low-carb version of the Mediterranean diet.

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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