With the start of every new school year, families have a lot to worry about- the their child will have a nice teacher, will excel in their studies, and will make new friends. However, parents of children with attention-deficit/hyperactivity disorder (ADHD) arguably have a little more to worry about. Children with ADHD are often unfairly labeled as “difficult students” by their teachers and described as disruptive, uncooperative, and incapable of paying attention and following instructions [1]. As a result, it can sometimes be difficult for children with ADHD to excel in the classroom. But what is ADHD, and why does it make school so much harder for some children?

ADHD is defined by the National Institute of Mental Health as a neurobehavioral disorder characterized by “an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development,” [2]. Let’s break this down further:

Inattention: a tendency to lack focus and persistence and be disorganized, but not due to a lack of understanding or defiant behavior.

Hyperactivity: incessant movement or restlessness e.g. fidgeting, tapping, or talking.

Impulsivity: process of decision making without consideration of potential consequences, especially with the potential of causing pain or harm, due to a desire for immediate reward or gratification.

 

ADHD is more prevalent in males than females and is most common amongst school-aged children [3]. While the American Psychiatric Association argues that approximately five percent of children have ADHD, other experts argue that the percentage is likely much higher [4]. In 2016, the National Survey of Children’s Health estimated that 6.1% of children ages 2-17 had ADHD. While there is no identified cause of ADHD, there are a number of contributing risk factors that can increase a child’s likelihood of developing the disorder, including [2]:

  • Genetics
  • Exposure to cigarette smoke, alcohol, drugs, and/or environmental toxins during pregnancy
  • Low birth weight
  • Traumatic brain injuries
  • Food intolerances and/or a poor diet

According to parental reports, 62% of children diagnosed with ADHD were taking medications for their condition [4]. Various medications are used to treat ADHD, the most common being the stimulant drug methylphenidate [3]. However, methylphenidate has many side effects, such as acute liver injury, and unknown long-term effects, raising concerns about its therapeutic usefulness [5]. Additionally, it is important to note that ADHD medications are not in fact able to treat the cause of ADHD, but rather the symptoms associated with the disorder. Dr. George Papanicolaou, DO has found that manipulating the diet of children with ADHD can be just as, if not more, therapeutic than using drugs [1]. The following are five dietary strategies that have been found to be beneficial for children with ADHD:

1. Consume foods with anti-inflammatory nutrients: One hallmark of ADHD is systemic, chronic inflammation, which is worsened by the highly inflammatory typical American diet [1]. One way to lessen inflammation is consuming foods rich in omega 3 polyunsaturated fatty acids (PUFAs) such as wild caught fish, walnuts, and chia seeds. Omega 3 PUFAs are vital for proper brain functioning- they preserve the fluidity and permeability of neuronal membranes, contribute to the development of neurons, and aid in the production of eicosanoids, which are anti-inflammatory signaling molecules [3].  

2. Complete an elimination diet: Emerging evidence is suggesting that ADHD may be promoted by food hypersensitivities. Specifically, when an individual consumes a food that they are sensitive to, it promotes inflammation- a key characteristic of ADHD [6]. As a result, some research suggests that eliminating common food allergens from the diet of a child with ADHD may improve behavior. Some foods and food components that are suggested to eliminate are gluten, dairy, eggs, soy, artificial colors and preservatives, high fructose corn syrup, and aspartame [6,7].

3. Focus on consuming whole versus processed foods: One trigger researchers have identified as a potential risk factor for developing ADHD is simple sugars– they may cause hyperactivity by increasing the production of insulin, thus stimulating the production of epinephrine and activating hyperactive behaviors [7]. Simple sugars are commonly added to processed foods, which should be avoided to reduce symptoms of ADHD. Instead, children with ADHD should consume diets rich in whole, unprocessed foods. Try replacing processed foods with fruits, vegetables, whole grains, nuts, seeds, lean poultry, and fish.

4. Optimize intake of vitamins and minerals: Many children with ADHD have numerous micronutrient deficiencies, potentially resulting from picky eating behaviors [1]. Researchers have identified that the key micronutrients to optimize in children with ADHD are iron, magnesium, vitamin D, and zinc. Deficiencies of these vitamins and minerals have been found to be associated with various neurological disorders, such as ADHD [8]. It is highly recommended that children with ADHD take a daily multivitamin to ensure optimal nutrient status [1].

5. Support your gut health: As we learn more about the connection between our guts and the brain, researchers are discovering that optimizing the quantity and quality of microorganisms in our digestive tracts is crucial for managing ADHD [9]. The following foods and food components are important for children with ADHD to consume on a regular basis to promote the growth of beneficial bacteria and prevent the colonization of pathogenic microorganisms in the digestive tract :

  • Probiotics are foods containing microorganisms that improve digestion, prevent infection of pathogenic bacteria, and prevent food allergies, which are common in children with ADHD [10]. Examples of probiotic foods include yogurt, sauerkraut, kimchi, kombucha, raw pickled veggies, tempeh, and raw apple cider vinegar. If children are averse to eating foods rich in probiotics, taking a probiotic supplement is a potential alternative.
  • Prebiotics are foods that contain non-digestible carbohydrates (NDCs), which serve as food for the beneficial microorganisms that live in our guts [10]. NDCs are vital to ensure optimal activity and growth of these healthy bacteria. Inulin and fructooligosaccharides are prebiotics that are commonly added to yogurts and kefirs. Examples of whole food sources of prebiotics include asparagus, bananas, barley, garlic, honey, maple syrup, mushrooms, onions, and oats.
  • Dietary fiber is the non-digestible component of plant foods, and there are two major types [11]. Soluble fibers are water soluble and aid digestion by forming gels in the digestive tract, which promotes feelings of fullness, reduces blood sugar by slowing the absorption of carbohydrates, and lower blood cholesterol. Soluble fibers are found in fruits, oats, barley, and legumes. Insoluble fibers are not water soluble and aid digestion by moving food through the digestive tract to prevent constipation and eliminating toxins. Insoluble fibers are found in wheat bran, corn, whole grains, cereals, and vegetables.

 

Once dietary strategies for managing ADHD symptoms are understood cooking meals that can help reduce a child’s ADHD symptoms becomes simpler. The following is a recipe created by Starkel Nutrition that is a good example of a meal that fits into the dietary guidelines presented above. Enjoy! 

 

QUICK QUINOA BREAKFAST PORRIDGE

This meal is very much like having oatmeal for breakfast. It’s hot, hearty, and delicious. It packs an extra punch of protein which gives it staying power.
PLUS it contains healthy fats, probiotics, antioxidants, and fiber! This recipe is very flexible – mix it up with different nuts, fruit, and spices
such as pecans, currants, allspice, and cardamom.
Preparation Time: About 15 minutes

Yield: about 4 cups

Ingredients:

  • 2 cup cooked quinoa
  • 1 cup unsweetened coconut milk
  • 2 teaspoons cinnamon
  • 1-2 tablespoon(s) maple syrup
  • ¼ cup raw walnuts, chopped
  • ¼ cup blueberries (fresh or frozen)
  • ¼ cup raspberries (fresh or frozen)
  • Yogurt for topping (unsweetened or low-sugar, dairy or non-dairy)
Directions: Combine quinoa, coconut milk, maple syrup, and cinnamon in a small saucepan and place over a medium low heat.  Once the mixture comes to a boil, turn it down to a simmer and allow it to cook for about five minutes or so or until the porridge has thickened a bit and is heated through. Stir in berries and chopped nuts. Top with two spoonfuls of yogurt. Enjoy!

 

 

Written by Hillary N., Bastyr student intern


References:

  1. Papanicolaou, G. (2017). Here’s how I treat ADHD: a functional doctor explains. The Ultrawellness Center. Retrieved from: https://www.ultrawellnesscenter.com/2017/09/06/heres-how-i-treat-adhd-a-functional-doctor-explains/
  2. May 2016. Attention Deficit Hyperactivity Disorder. National Institute of Mental Health. Retrieved from: https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
  3. Konigs, A, Kiliaan, AJ. (2016). Critical appraisal of omega-3 fatty acids in attention-deficit/hyperactivity disorder treatment. Neuropsychiatric Disease and Treatment, 12, 1869-1882. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4968854/
  4. March 2018. Attention-Deficit/Hyperactivity Disorder: Data and Statistics. Centers for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/ncbddd/adhd/data.html
  5. September 2018. Methylphenidate. National Center for Biotechnology Information, PubChem Open Chemistry Database. Retrieved from: https://pubchem.ncbi.nlm.nih.gov/compound/methylphenidate#section=Top
  6. Pelsser, J. et al. (2011). Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. The Lancet, 377, 494-503. Retrieved from: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2810%2962227-1
  7. Kim, J., Chang, H. (2011). Correlation between attention deficit hyperactivity disorder and sugar consumption, quality of diet, and dietary behavior in school children. Nutrition Research and Practice, 5(3), 236-245. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3133757/
  8. Reza, M. et al. (2015). The relationship between serum vitamin D level and attention deficit hyperactivity disorder. Iranian Journal of Child Neurology, 9(4), 48-53. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670977/
  9. Gonzalez, A. et al. (2011). The mind-body-microbial continuum. Dialogues in Clinical Neuroscience, 13(1), 55-62. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139398/
  10. Wolfram, T. (2018). Prebiotics and probiotics: creating a healthier you. Academy of Nutrition and Dietetics, Nutrient Rich Foods. Retrieved from: https://www.eatright.org/food/vitamins-and-supplements/nutrient-rich-foods/prebiotics-and-probiotics-creating-a-healthier-you

April 2012. Fiber. Oregon State University, Linus Pauling Institute, Micronutrient Information Center. Retrieved from: https://lpi.oregonstate.edu/mic/other-nutrients/fiber

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