I read a very recent article that stated there were roughly 1 million more children in the US diagnosed with attention deficit/hyperactivity disorder in 2022 compared to 2016. The numbers given were 6.1 million in 2016 to 7.1 million in 2022.
What is going on?
Let me preface this article by stating that there is no evidence that food or diet causes ADD or ADHD (attention deficit disorder and attention deficit hyperactivity disorder) however, there is evidence that diet and nutrition can affect attention, focus, and behavior. There is also evidence that certain nutritional deficiencies are related to ADD or can lead to learning problems. I do not advocate any particular ADD diet (for writing purposes, I will use ADD to refer to both ADD and ADHD). I will present what is known to be beneficial for both the brain and ADD.
Depiction of the concept of ADHD with a head made of paper and letters above spelling ADHD with scrambled, twisted ribbon over the brain.
Macronutrients known to improve brain health and avoid blood sugar fluctuations include:
Protein
Complex carbohydrates
Fats, specifically omega-3 fatty acids.
Healthy protein sources include beans, eggs, lean meats, seafood, dairy, and nuts. Eating breakfast with protein is a great way to boost concentration and stabilize blood sugar. Combine this with a complex carbohydrate, and your child will be ready to start the school day.
Examples include
eggs on whole grain toast or whole wheat tortilla
whole-grain toast with nut butter
oatmeal with nuts, milk, and berries
smoothie with milk and full-fat Greek yogurt.
Complex carbohydrates, such as those from whole grains, beans, fruit, and vegetables (foods high in fiber), are broken down into glucose slower than simple carbohydrates. Complex carbs keep blood sugar stable, helping avoid some hyperactivity and erratic behavior caused by blood sugar fluctuations.
Omega-3 fatty acids aid brain development and function. Sources of this polyunsaturated fatty acid include seafood, such as salmon, shrimp, and tuna, nuts and seeds, olives, avocado, olive and canola oils, and omega-3 fortified eggs. Some research has shown beneficial effects in supplementing children with ADD with omega-3 fatty acids, especially those with impulsiveness. Correct dosages are not known; this is worth discussing with your doctor.
Photo of dietary sources of omega-3 fatty acids such as seafood, eggs, nuts, seeds, avocado, and oils.
Micronutrients have also been looked at and include
Iron
Zinc
Magnesium
Vitamin D
Iron is a mineral whose deficiency is associated with ADHD. Iron deficiency is a common nutritional deficiency. High-risk groups include vegetarians and vegans, menstruating girls, children with a high milk intake (more than 24 ounces daily), and those living at high altitudes. Iron is easy to check with a blood test and easily supplemented. Testing should be considered in children with ADD.
Zinc is another mineral that may benefit ADD, but more research is needed.
Magnesium and vitamin D are being looked at for ADD, but more studies need to be done. Any child who is a picky eater or lacks food groups can benefit from taking a children’s multivitamin with iron. Any additional supplements should be discussed with your doctor since high doses of vitamins can be toxic.
What is Best to Avoid or Minimize with ADD?
Sugar/added sugars
Saturated fats
Caffeine
Food dyes
Food additives
Simple carbohydrates
Photo of an assortment of ultra-processed and fast foods full of sugar, saturated fats, dyes, and simple carbohydrates which are best minimized with ADD.
Elimination Diets
An elimination diet means avoiding foods that may trigger or worsen symptoms. This applies to various conditions; everyone is different regarding what they do and don’t tolerate. There are some foods that either research or observation have been seen to help or worsen ADD symptoms. If you notice that certain foods or ingredients worsen symptoms in your child, consider eliminating that item for two weeks. You can reintroduce the item to determine whether the effect recurs, if so, avoid it altogether.
The American Academy of Pediatrics and other specialists agree that children with ADD should avoid certain items. These are:
Artificial dyes in food, especially
Red dyes # 2, 3, and 40
Yellow dyes # 5 & 6
Food additives, including
Aspartame (an artificial sweetener)
Nitrites (from processed meats)
Monosodium glutamate (MSG) (used in Asian food preparations, fast foods and processed meats)
Are Supplements Warranted?
Bottles of various supplements marketed to promote brain health. Supplements are not regulated and so far have not been proven to benefit ADD.
Many professionals believe that if a child has a healthy, well-rounded diet, then supplements are not necessary. If that is not the case, then a multivitamin with iron is all that is recommended.
In general, there is insufficient research to determine whether any specific supplements are beneficial other than iron - if there is a deficiency. These are best discussed with your doctor. An omega-3 fatty acid supplement might be helpful, especially for a picky eater, but dosing is uncertain.
What About Amino Acids?
Amino acids are the components that make proteins. There are 20 amino acids - our body makes 11; the other 9 (called essential amino acids) come from foods. Any food that is protein has amino acids.
Complete protein foods contain all nine essential amino acids. Most of these come from animal sources, but some are from plants. These foods include:
Beef
Poultry
Fish
Eggs
Dairy
Soy
Quinoa
Buckwheat
You can also combine incomplete protein foods to make a complete protein, such as nut butter with whole grains or whole grains with legumes.
Some essential amino acids help make neurotransmitters in the brain, so are being studied for ADD. So far, there are not enough studies to warrant any supplementation for amino acids, especially since our body makes them, and the others are easily obtained from diet. Be wary of anyone telling you otherwise. Instead, focus on getting amino acids from complete protein foods or combinations of incomplete proteins.
There are also all sorts of "brain-boosting" supplements available, some marketed for children. I recently became aware of one called Brillia, with two formulations, one for adults and one for children. The active ingredient in Brillia is an immune globulin, or antibody, made against the S100B protein, so it sounds scientific. A problem with this approach is that studies done so far have not shown higher levels of the S100B protein in children with ADHD compared to controls. Another problem is that antibodies usually are given by injection or intravenously (by IV), not by mouth. Antibodies taken orally are poorly absorbed and usually degraded by stomach enzymes. Then it would have to pass into the brain, which is difficult for an antibody, since it is a large molecule. Needless to say, I have my doubts regarding such a product.
Remember that supplements are not regulated and do not have to show any proof of effect to be marketed.
Here are a reasonable 10 steps:
Focus on a healthy diet full of natural, whole foods
Minimize processed foods
Eliminate sugar-sweetened beverages and most added sugars
Emphasize complex carbohydrates
Avoid caffeine
Be aware of the effects of food dyes and additives
Consider testing for iron deficiency
Give a multivitamin with iron to picky eaters
Observe for any food triggers to remove from your child’s diet
Beware of anyone selling supplements that claim to help ADD
These steps are also beneficial for brain, mental, and physical health. Now is a good time to eliminate potential food triggers from your child’s diet to observe for improvement, before school starts.
There is something to be said for using nutrition to maintain health.
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