What do you know about ADD or its close cousin ADHD? If your child is hyper, struggles to focus or is disorganised then they could hold the answer. Here’s a blog showing what ADD and ADHD are and how nutrition can play a huge role in helping them.
A child with ADD generally falls into one of two sub-types:
- The Inattentive Child – often these are the kids who are day dreamers, they are usually disorganised, forgetful and unable to carry out instructions easily.
- The Hyperactive and Impulsive Child – these kids tend to struggle to sit still, are fidgety, interrupt and talk excessively. This subset is often labelled as ADHD (Attention Deficit Hyperactivity Disorder).
For ADD or ADHD to be formally diagnosed by a doctor in the UK at least six symptoms of inattentiveness, or six symptoms of hyperactivity and impulsiveness need to be apparent in at least two settings (at home and at school for instance) and should be considerably interrupting the child’s ability to learn, affecting their social skills and behaviour and disrupting both home and school life.
ADD is thought to be strongly genetic, so you may recognise these traits in other family members. It is thought to be that those people genetically predisposed to ADD struggle to balance the neurotransmitters dopamine and norepinephrine which help us regulate focus, attention and the pleasure reward. This is why the medications for ADHD help to boost up norepinephrine and dopamine. Norepinephrine helps increase attention and alertness; and dopamine helps you focus.
However even with time-released medication options now available, there is only a short window of the day that these medications can be useful (i.e. for the hours when they are at school and they usually need a top-up at lunch time) which means that kids with ADD can struggle a great deal outside these times and when the medication is wearing off. Also, some kids get side-effects from taking the medications – everything from a loss of appetite, to stomach pain, to headache, to anxiety and sleep problems.
The kids we tend to see in our clinic are those who are either too young to take medication (Concerta, Equasym, Medikinet, and Ritalin can only be prescribed from age 6) and those kids who get significant side effects from the medication. We also see kids whose parents are looking to help them more holistically, with the aim to help them be more settled, happier and focused whether they are taking the medications or not. Many kids we see do not reach all the criteria for a full ADD diagnosis but are struggling with focus, concentration, impulsivity or hyperactivity.
The motivation for parents to bring their child to our clinic is that they are keen to have some lab tests run, to check there aren’t any nutrient deficiencies or metabolic issues going on. Remember that a child psychiatrist or a paediatrician in the UK will purely diagnose a child through an interview and observation and will very rarely offer a blood test to check for vitamins, minerals, essential fatty acids or metabolic problems. Shortfalls in important brain foods can play a significant role in how a child can think, behave and concentrate and below you will learn that the symptoms of ADD often reflect nutrient deficiencies.
So Where Does Nutrition Play A Role In Helping Your Child Thrive And Focus?
Many parents of the kids that we see in our clinic and ADHD experts have made the link between their child eating poorly and their focus and concentration. A 14-year study of around 3,000 children published in the Journal of Attention Disorders found that kids who are a typical “Western-style” diet loaded up with refined sugar, white carbohydrates, and unhealthy trans fats were twice as likely to be diagnosed with ADHD than kids eating a healthier diet low in sugar and white carbs and rich in omega-3 fatty acids and fibre from wholegrains and vegetables.
One team of ADHD researchers from Colorado even theorised that that excess sugar intake is the cause of ADHD and chronic excess consumption blunts the dopamine receptors which in term causes the child to crave and eat even more sugar in order to help them feel good. According to this theory, eventually these overused dopamine receptors start to wear out, leading to lower levels of dopamine and thus heightened symptoms of ADHD.
This is partly why I encourage a healthy diet rich in protein, complex wholegrain carbohydrates, oily fish, fibre, fresh fruits and vegetables and parents see quite a change in their kids once they have switched to a healthier diet. It is not about cutting out sugar entirely but being clever about how your kids consume it. This is explained in-depth in my bestselling brain-food book The Good Stuff.
The Gut Connection
Did you know that different species of bacteria inside our intestines are the building blocks for creating our neurotransmitters, including dopamine and norepinephrine? That’s why we need to ensure we are continually supporting our own individual gut microbiomes by eating a wide diversity of fruits, vegetables, nuts, seeds and pulses as well as fermented foods such as yoghurt, kefir, apple cider vinegar, kimchi and sauerkraut.
Lactobacillus species for instance helps us produce acetylcholine which is important for a good memory. This Lactobacillus and Bifidobacterium together help us make gamma-amino butyrate (GABA) which is a brain hormone that keeps us cool, calm and collected. Escherichia bacterium produces norepinephrine, serotonin and dopamine and Bacillus species help to produce norepinephrine and dopamine – these are the very neurotransmitters that those with ADHD find tricky to build.
Research has found that those with ADHD do have a reduced diversity of microbes it the gut. So, it seems prudent that if you want to help your child with ADHD build these neurotransmitters, naturally, then a good first step would be to support their gut flora so that these important bacterial species are thriving in your kids’ tummies. This is where probiotic supplementation and fermented foods come in.
Shortfall in Magnesium
In our clinic we are keen on running laboratory tests to establish whether a child presenting with ADHD symptoms has any nutritional deficiencies; and the one that comes up almost every time is a significant shortfall in magnesium. These clinical findings have been replicated in a small study of Egyptian children in where 72% of the kids that presented with ADHD were also deficient in magnesium.
Since magnesium plays a role in over 300 enzyme systems in the body which help us keep calm, relaxed and plays a particularly important role in creating neurotransmitters including dopamine, this is a key nutrient to get right for kids presenting with ADD symptoms.
Magnesium is often combined with Vitamin B6 which is a cofactor vitamin that helps cells use magnesium. In a French study of 40 children with ADHD this magnesium and B6 combination helped kids to be less hyperactive, aggressive and irritable and they also had better focus at school.
Below are some of the foods rich in Magnesium however Magnesium supplementation is also possible.
Magnesium Rich Food Sources:
- Green vegetables
- Nuts, seeds and pulses
- Banana and raspberries
- Fish such as salmon and mackerel
Consuming enough iron in the diet is essential for the developing brain. Iron helps our blood transport oxygen to our brain cells, and this is why iron-deficient kids struggle more with maths and language as well as their focus and concentration. What is most interesting is that in a study published in BMC Psychiatry, those with iron deficiency and anaemic were 67% more likely to be diagnosed with ADHD or mood disorders. And in another study 92% of kids with ADHD had low ferritin (iron stores in the blood).
Iron Rich Food Sources:
- Red meat
- Leafy green vegetables
- Nuts and seeds
- Lentils and beans
- Baobab powder
Not Enough Zinc
Zinc is essential for the creation and operation of every bodily cell. It helps you think amongst other things and is a key nutrient needed to create dopamine, norepinephrine and our feel-good neurotransmitter serotonin. Interestingly in one study 60% of kids diagnosed with ADHD were deficient in zinc and in another study, zinc supplementation was significantly superior to placebo in reducing symptoms of hyperactivity, impulsivity and impaired social skills in those with ADHD. Zinc is another common shortfall we find in our laboratory testing in our clinic and we often find this is among the kids with attention and concentration issues as well as those who are picky eaters.
Zinc Rich Food Sources:
- Dairy products
- Pulses, seeds and nuts
Essential Omega 3
Did you know that 60% of your brain is made up of fat? It specifically depends on essential fatty acids from our diet and this is why we need to consume healthy fats to fuel our brain function. Omega 3 is the most important oily brain food and when kids are little then need lots of lovely DHA to help with brain development.
After the age of 6 or 7 they need more of the Omega 3 EPA form and less of the DHA and this helps keep chronic inflammation in check. Chronic inflammation is a hot topic in medical research right now and has been linked to far reaching issues ranging from ADHD, depression, anxiety and addiction through to type 2 diabetes, cardiovascular disease and cancers.
Omega 3 Rich Food Sources:
- Oily fish like salmon and mackerel
- Whole organic milk and milk products
- Omega 3 rich eggs
- Chia seeds
- Extra-virgin rapeseed oil
- Flax seeds
ADHD Kids Growing Up
Interestingly the nutritional shortfalls associated with ADHD, are also those found in those with addictions and mood disorders, and include zinc, magnesium and omega 3. The same goes with a depleted microbiome, which is associated with alcoholism and substance abuse as well as anxiety and depression. Since kids with ADHD are more likely to become addicted to alcohol, cigarettes and narcotics and well as suffer from mental health issues like depression in adulthood, shouldn’t we all be trying to sort these underlying nutritional and gut issues out when they are little rather than just putting them on medication to manage the issues?
Some may need both medication and nutritional approaches but if these simple, safe and natural interventions can help in any way to prevent greater behavioural and mental health issues later on life then I see this as a very good investment! I always follow the mantra – “always aim to sort out health niggles when kids are little, so they don’t turn into greater ones when they are older” and the ADHD story is a big reason why!
- ADHD is associated with a “Western” dietary pattern in adolescents, Howard AL et al.
- Attention-Deficit/Hyperactivity Disorder: Is it Time to Reappraise the Role of Sugar Consumption? Richard Johnson et al.
- The Gut Microbiome and the Brain, Leo Galland.
- Reduced microbiome alpha diversity in young patients with ADHD, Alexander Prehn-Kristensen et al.
- Magnesium supplementation in children with attention deficit hyperactivity disorder, El Baza et al.
- Magnesium in Prevention and Therapy, Uwe Gröber et al.
- Improvement of neurobehavioral disorders in children supplemented with magnesium-vitamin B6. Attention deficit hyperactivity disorders, Mousain-Bosc M et al.
- Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study, Chen MH et al.
- Iron deficiency in children with attention-deficit/hyperactivity disorder, Konofal E et al.
- Natural Product-Derived Treatments for Attention-Deficit/Hyperactivity Disorder: Safety, Efficacy, and Therapeutic Potential of Combination Therapy, James Ahn et al.
- Double-blind, placebo-controlled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder, Bilici M et al.
- Magnesium, zinc and copper estimation in children with attention deficit hyperactivity disorder (ADHD), FaridaElbaz et al.
- Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States, Halterman JS et al.
- A Review on the Role of Inflammation in Attention-Deficit/Hyperactivity Disorder, Leffa DT et al.
- ADGRL3 (LPHN3) variants predict substance use disorder, Mauricio Arcos-Burgos et al.
- A Review of Co-Morbid Depression in Pediatric ADHD: Etiologies, Phenomenology, and Treatment, W. Burleson Daviss.
- Magnesium and Zinc Involvement in Tobacco Addiction, OMICS Mihal Nechifor.
- Omega-3 Levels and Nicotine Dependence: A Cross-Sectional Study and Clinical Trial, Zaparoli JX.
- The Microbiota, the Gut and the Brain in Eating and Alcohol Use Disorders: A ‘Ménage à Trois’? Jamie E. Temko et al.