The Role of Diet and Nutrition in Managing Symptoms of ADHD: What Practitioners Should Know

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects millions of people. According to the CDC, ADHD roughly affects about 6 million (9.8%) of youth, whereas NIH claims 562.8 million (9.8%) of adults. People who suffer from ADHD tend to have learning disabilities, which affect their school, social, or work life. Pharmacology is one of the first treatments; recent developments have shown that long-term care with pharmacology does significant damage to the brain of developing people; therefore, alternative methods such as dietary management of ADHD are explored. With diet and nutrition one can support the development and neuroplasticity of the individual and their functioning should improve. It is long known that what we eat plays a crucial role in the health of our bodies, it is no coincidence that it also plays a role in our mental health. When nutrition is explored in the context of psychological disorders it is called “nutritional psychiatry”. Therefore diet, nutrition, and supplementation may help improve certain ADHD symptomology.

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Understanding ADHD and Its Symptoms

ADHD is a neurodevelopmental disorder with many symptoms that affect executive function, categorized with moments of inattention, hyperactivity, and/or impulsivity. The overview of ADHD symptoms include “careless” mistakes in schoolwork/work and other activities, trouble holding attention on tasks/activities, appearing to not listen when spoken to directly, an inability to follow through on instructions, and failure to complete tasks, they may have trouble organizing tasks, activities, avoidant/reluctant/dislike of mental tasks over a long period, loses objects necessary for tasks, easily distractable, often blurts out or talks excessively or has a difficult time waiting for their turn, they may climb on objects (if a child) or feel restless. Some complexities when exploring the diagnosis of ADHD can be, appropriate behavior for age, but when compared to others of the “same age” who are slightly older, for instance, a child born in August vs a child born in January of the same year will have a different maturity level. 

If a patient is around 10 years old, we as clinicians, parents, teachers, and caregivers might forget that or perceive the child to have a condition if we fail to consider when they were born.

The Connection Between Diet, Nutrition, and ADHD

Current research and understanding describe when nutrients are lacking from the diet the more severe the symptoms of ADHD are, and poorer treatment outcomes emerge. In addition, to the lack of certain nutrients, there is the observation that certain dietary patterns exist and will either promote ADHD potential, such as “western-like”, “sweet”, “snack”, “junk food” and “processed” whereas patterns such as “Mediterranean”, “DASH” and “Vegetarian” show an inverse relationship. Certain foods such as processed foods affect the brain with an increased risk of depression, anxiety, and cognitive decline. With a processed diet, the shift from Omega 3s to Omega 6s promotes inflammation and may interfere with Omega 3s’ conversions to active forms. Without proper forms of nutrients and adequate supply, the body will have inadequate neurotransmission, and gene expression, which directly affects neurogenesis and neuronal survival. All of which are integral to creating a healthy optimal environment for functioning. A commonly discussed aphorism “form determines function”, if the body cannot build the proper foundations then the body will have weakness and strive for homeostasis, placing resources in the most critical areas for survival. This process will likely place unnecessary strain or stress on the system and it will likely show in behavior and mental functioning.

One study explored eating behaviors and increased risk of ADHD, found that when sugar was eaten it would enter the bloodstream and cause rapid changes in glucose levels and produce more adrenaline (true for those with and without ADHD), providing short-term energy for physical activity, excitement and impulsiveness, tremors, anxiety, and poor concentration. In addition to these symptoms, it may also elicit the reward system, specifically dopamine. In addition to these findings, they discovered that their physical growth deviated greatly from the controls, both height and weight (weight loss/obesity). It is possible that once patients were medicated it would suppress their appetite causing the loss of weight.

Nutritional Deficiencies and ADHD

Common macro nutritional deficiencies observed in ADHD and micronutrients that are deficient in individuals with ADHD include Omega 3 and omega 6 fatty acids, zinc, iron, magnesium, copper, manganese, and Vitamin D. Omega 3 and 6 are needed in a particular balance to promote proper neuro formation of the brain and nervous system including repair, in addition to proper formation it modulates the inflammatory pathway, which will either quell the inflammation or promote it depending on which omega fatty acids are available. Zinc is important in cellular adhesion (cadherins) and immune health. With low zinc, neutrophils may increase which may promote inflammation and suppressed or optimal immune health. Iron is needed for proper heme formation which carries our oxygen. Without proper oxygen, our bodies’ cycles go from the TCA energy pathway to the lactate energy pathway which is not efficient or effective in the long term. Magnesium is imperative for over 300 enzymatic processes in the body, it is also imperative for muscle relaxation, and proper neurotransmitter function. Copper deficiency may have signs of anemia, hypopigmentation, hypercholesterolemia/abnormal lipid metabolism, connective tissue disorders, and an increased risk of infection.  Manganese deficiency may cause poor growth in children, bone demineralization, skin rashes, hair depigmentation, decreased cholesterol, altered mood, altered lipid and carbohydrate metabolism, and glucose intolerance. Vitamin D deficiency is linked to multiple psychological disorders, ADHD included, and it is critical to bone and calcium regulation.

Testing is an effective way of exploring the body to determine the course of action best suited for the individual. Such testing should include a CBC, for a baseline of what is occurring in the body, and then in addition one could run labs on nutritional status with labs such as SpectraCell's Micronutrient Test: which will explore more than 30 vitamins, minerals, and other nutrients to identify excess and deficiencies. Sanesco & NeuroLab's HP Profile: a urine sample is analyzed for seven neurotransmitters that are important for neurological functioning, where neurotransmitters depend on nutrients to be built.

Diet and Food Sensitivities in ADHD

Since the 1980s, Asthma, Allergic Rhinitis, Atopic Dermatitis, Allergic Conjunctivitis, and food allergies have all been shown to have a correlation and possible causative effect on ADHD and the severity of symptoms. The effect starts with Immune dysregulation and inflammation. Activation of basophils, mast cells, and eosinophils in allergic disease processes is proinflammatory, releasing mediators and cytokines that in turn promote the state of inflammation, these are also found in ADHD and Autism Spectrum Disorders (ASD). The infiltration of immune cells such as macrophages across the blood-brain barrier alters neural functions, which may play a role in psychiatric disorders such as ADHD and ASD. Since this is understood that there is a connection, it can be valuable to explore food allergies including IgA, IgE, and IgG.

Sodium benzoate is a food preservative and pickling agent used for its antimicrobial and antifungal properties and is shown to be consumed at increased levels in those with ADHD. Food colorings may also exacerbate symptoms of ADHD and other neurobehavioral conditions, in addition to contributing to hypersensitivity to food and the environment leading to promoted inflammation. Yellow No.5 and Yellow No.6 are shown to have highly potent effects that heighten ADHD symptoms and are estrogenic. Red No. 3, and Red No. 40 are linked with carcinogenic effects and hypersensitivity. If what we eat can contribute to hypersensitivity it only enforces the notion that we must eliminate foods that cause havoc.

Rupa Health has numerous food allergy testing options. If a person was never tested for IgE it is important to start here, the Precision Point's P88 Dietary Antigen Test: measures IgE, IgG, IgG4, and C3d reactions to 88 common foods to identify hypersensitivities. Other options are Mosaic Diagnostics' IgG Food MAP with Candida + Yeast: which explores 190 foods common in the Western, Asian, and Mediterranean diet, and candida and yeast using a blood sample to explore hypersensitivities. Another way to explore not just sensitivities but the overall health of the gut is to run one of the following tests: Diagnostic Solutions' GI-MAP + Zonulin: explores a stool sample for parasites, bacteria, and fungi to provide information to enable personalized treatment for gut dysfunction. This test also measures Zonulin which is a marker for leaky gut. 

Doctor's Data's Comprehensive Stool Analysis + Parasitology: a stool sample is evaluated for bacteria, parasites, yeast, infectious pathogens, antimicrobial susceptibility to prescription and natural agents, and key markers of digestion, absorption, and inflammation are identified. This information can help determine the causes of gastrointestinal symptoms and chronic conditions. Although these are just a few options, there are numerous to choose from.

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Beneficial Dietary Patterns for ADHD

An Asian study explored the dietary patterns of children with ADHD. They found that those who ate sweet dietary patterns (chocolate, chips, and fruit jams) were associated with an increased risk of attention deficit, hyperactivity, and other ADHD symptoms, whereas a vegetable dietary pattern was associated with a lower risk of ADHD symptoms.

The Standard American Diet, (SAD) is high in carbohydrates and processed ingredients which are shown to have influences on our Dopamine- Serotonin levels or reward system, which plays a role in processing, all of which have negative effects. A well-known anti-inflammatory diet called “Mediterranean” provides key nutrients to our immune, psychological, and general health and is an effective way to incorporate more antioxidants, fruits, vegetables, and lean meats. Patterns such as “Mediterranean”, “DASH” and “Vegetarian” show an inverse relationship with symptomology. When diet improves, the energy processes improve, and the system appears to work almost effortlessly and efficiently; improving energy, mental clarity, and symptoms.

The Role of Supplements in ADHD Management 

In addition, a whole foods diet, also ensures that the diet has the precursors to make glutathione, along with vitamins and nutrients such as folate, Vitamin B6, magnesium, zinc, carnitine, serine, glutamine, and choline help improve the person’s thinking, clarity, and decision making. Choline is a precursor to acetylcholine which regulates memory, focus, and muscle control. Omega 3 can improve memory, provide a great building foundation for cells and neurons, and quell inflammation. Glutamine may have a calming effect as it is a precursor to the neurotransmitter GABA, which helps mood, focus, and hyperactivity. If we are in a state of calm, then it is impossible to be in a state of fight/flight/freight which can be reflected in hyperactivity.

Carnitine is safe and effective in treating inattention and may help with aggressive issues in boys. Zinc is key to our cadherins (makes our cells stick together and create membranes), our immune health, and a cofactor for dopamine, without zinc, we may see increased membrane permeability, and higher neutrophil counts – which signifies a higher likelihood of inflammation and infection. Therefore, the addition of zinc is posed to improve information processing and behavior. Magnesium deficiency is linked to poor function of neurotransmitters – all of which aid in the control of emotions, reactions (chemical, physical, and social), hyperactivity modification as magnesium is essential for processes to “relax”, attention and concentration likely due to not feeling agitated or restless, and has a synergistic effect with magnesium.

Vitamin B6 supplementation with high doses is just as effective as Ritalin, possibly due to its role in raising serotonin levels. Precursors to health is the health of the mom during pregnancy. If she was deficient in folate, this places the child at a predisposition to have ADHD, if the child or mom was unable to process B vitamins due to the MTHFR gene this will place both at a predisposition for folate deficiency. Antioxidant status is important as the more oxidants there are in the system the more inflammation they cause. If they have an oxidative imbalance it will play a crucial and direct role in glutathione, either clogging the system or utilizing it causing deficiency.

Integrating Diet and Nutrition into a Holistic ADHD Management Plan

Integrating nutrition in ADHD care with low antigenic - wholefoods, high vegetables, and no food colorings and preservatives diet without behavior therapy, medication, and other lifestyle interventions proved to have positive outcomes for those with ADHD symptoms. If, these patterns along with a holistic approach to ADHD including removal of food intolerances, improvement of the gut-microbiota-brain axis, and therapies, those with ADHD can live a neurodivergent life that feels productive rather than overwhelmed by possible failure, disappointment, and frustration.

Since ADHD has a lot of flight (climbing, fidgeting, distraction, blurting out, etc.) relearning social cues will be important, this is known as behavioral therapy, such as Applied Behavioral Analysis (ABA) and/or Cognitive behavioral therapy (CBT). If we consider our macroenvironment (how we interact with the world/physical manifestation of disease) to be a reflection of microenvironment (pathology within the body at the cellular level) then it shows that both are inflamed, the ADHD patient may be agitated or agitating those around them, by their inability to sit still, listen, and complete tasks in an orderly fashion, and the same goes for their cellular processes, their energy may appear unregulated, inflamed, agitated.

With a multidisciplinary approach using holistic therapies, targeting behavior, medication, and supplements to target cellular pathways, cognition, and function, the likelihood from the start of therapy to improvement will be cut significantly. To make leaps and bounds in care requires often an overhaul of life, from the macro to the micro. Therefore, small consistent changes and efforts can make long-lasting impactful changes in the life of the person. Holistic approaches to ADHD care and management are likely to have a multifaceted improvement in the person’s well-being.

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Diet and Nutrition for ADHD Management: Key Takeaways

When exploring ADHD in your patients, consider their age, their diet pattern, and what foods they are craving, and test for deficiencies and allergies. As we know a deficiency in key nutrients, and/or hypersensitivities have a magnitude of issues for the health of the person. Although diet and lifestyle changes are often met with resistance, you can empower them, especially for those not want to be on long-term or downright refuse pharmaceuticals. Diet is one avenue where they have control and can take ownership of their well-being. This empowerment and autonomy are crucial to the long-term care of individuals. Be encouraged to read, explore, and try; you might end up doing the least harm with the greatest benefit. Comprehensive ADHD management with nutrition provides care of autonomy, empowerment, lifestyle changes, and a better long-term health outcome.