During the COVID-19 pandemic, our clinic saw a staggering increase in ADHD diagnoses among our clients, many of them women. While studies suggest that men are more commonly diagnosed than women, many women can slide under the radar, and miss diagnosis, as it presents very differently across genders.
It is estimated that 10.5 million American adults are living with ADHD. A study published in JAMA, reported that diagnosis of ADHD in adults is now four times that of children, and its prevalence more than doubled between 2007 and 2016, from .43 percent to .96 percent. However, other studies suggest even higher rates, ranging from 2.5 percent to 4.4 percent, with more men diagnosed than women. Some researchers suggest that ADHD may be underdiagnosed in adults, as well.
Why is ADHD on the rise?
Regardless of age, ADHD is being diagnosed more than ever before. However, that does not mean the condition itself is more common. According to Psychology Today the increase in diagnoses can be attributed to several factors:
- Increased access to healthcare. Thanks to state and federal efforts, more individuals have access to healthcare, resulting in more diagnoses.
- Decreased stigma. Slowly the stigma surrounding mental health conditions and treatment is becoming more accepted.
- Better awareness. Individuals, parents, educators, and the medical community are more aware of ADHD and its symptoms, leading to additional ADHD diagnoses.
- Changes to how ADHD is defined. In the past, only children who were hyperactive were diagnosed with ADHD. The definition was later expanded to include other symptoms associated with inattention. As a result, more individuals were diagnosed with the disorder. This is particularly true in girls, who more commonly exhibit signs of inattention or combination types, rather than solely hyperactivity.
Specially trained ADHD coaches can play an integral role in helping you identify your strengths and opportunity areas when it comes to executive functioning skills, organization, planning, time management, and even emotional regulation – all of which may be challenging for those with ADHD.
Coaches are not typically covered by insurance. However, dietitians and nutritionists like those here at Starkel Nutrition, ARE commonly covered.
In addition to the food piece and how that may be impacting your symptoms (often exacerbating), our nutritionists ALSO work on behavioral change elements and habits related to self -care. We strategize ways to gamify helping you get to bed on time (revenge bedtime procrastination, anyone?), create and maintain supportive morning routines, prioritize movement, and work with you to hone your energy and motivation. Whether you’re medicated or not, we can help you to create plans that are doable and sustainable given your skillset and lifestyle.
Someone with ADHD may find it challenging to plan and prepare foods due to executive dysfunction. This is a limitation in how the brain manages thoughts, tasks, time and decisions.
Common Eating Behaviors in Children and Adults with ADHD
- Skip meals, but eat 5+ times/day
- Drink more sugar sweetened beverages
- Fewer fruits and vegetables
- More screen time, less organized movement time
- Lowered self-regulation in eating/distracted eating common
- Poor meal planning
- High reliance on convenience foods, immediate choice
It is important to note that ADHD is not caused by diet and diet cannot cure ADHD.
In fact, the most common and best understood link to ADHD is genetics. This means that you are more likely to inherit ADHD if a family member also has it. In addition, other potential causes and risk factors may include brain injury, environmental risks such as lead exposure, alcohol and tobacco use during pregnancy, premature birth, and low birth weight.
With that being said, nutrition in combination with other ADHD treatments, such as therapy and/or medication, can be effective ways to manage ADHD symptoms and their severity.
The best management strategy is the one that works best for you. Knowing what foods to focus on and what foods should be avoided with ADHD can help.
Research around ADHD and food is still new and there is a lot of work to be done. While there is no general ADHD Diet (since all diets should be individualized), we are sharing some evidence-based strategies and nutrients that may help in managing symptoms.
How does ADHD impact nutrition
There is no arguing that ADHD can affect the nutrition and overall health of those living with it. Here are just a few of the ways that ADHD can impact nutrition:
- Forgetting to eat
- Low motivation to cook
- Decision overwhelm
- Sensory sensitivities to certain smells, sights, or textures
- Food boredom
- Binge eating
- Ignoring hunger cues
- Eating for stimulation (aka dopamine seeking)
- Suppressed appetite from certain ADHD medications
How does nutrition impact ADHD symptoms
In turn, consistent and balanced nutrition can have a positive effect on certain ADHD symptoms. These include:
- More energy
- Less jittery
- Fewer headaches
- Stimulation
- Less likely to binge
- Improved focus
- Release of dopamine
- Less irritable
A simple internet search will highlight many types of restrictive and elimination diets purported to improve behavior and attention. However, evidence is limited and many of them are highly controversial.
Furthermore, following a restrictive diet could potentially lead to nutrient deficiencies and possibly the development of food aversions, especially in children. Nutrient deficiencies may worsen ADHD symptoms.
So following any of these diets without proper precautions has the potential to produce the opposite intended effect on symptoms. We encourage you to work with your physician or nutritionist for advice and guidance to help personalize a plan.
What diet is best for ADHD?
The best diet for ADHD is one that is personalized to you and your symptoms.
Some general nutrition tips for ADHD’ers:
- Find your trigger foods, if relevant
- Avoid the foods you are intolerant, sensitive or allergic to
- Eat consistently throughout the day to manage blood sugar, energy and focus
- Eat enough protein
- Add to your safe foods, if they are not nutritionally balanced
- Stay hydrated
Nutrients to focus on: Macronutrients
The macronutrients include protein, carbohydrates and fat. A healthy diet consists of a balance of these three things.
Protein
Protein is important for a variety of reasons. It provides the body with amino acids, which are used to make the chemicals in the brain (aka the neurotransmitters). These include things like dopamine, serotonin and norepinephrine. Neurotransmitters help communicate messages from your brain to the rest of your body.
Protein can also help you feel full longer and maintain blood sugar levels, preventing energy crashes, while supporting overall mood stability.
Foods high in protein:
- Nuts and seeds
- Beans and lentils
- Soy products like tofu
- Eggs
- Dairy products
- Meat like poultry, beef and pork
- Fish
- Shellfish
Carbohydrates
Carbohydrates are the most efficient source of energy for your body. They provide all your cells with fuel in the form of glucose or blood sugar. This helps maintain all the functions of your body and organs, as well as any physical activity that you do.
Avoiding dips and peaks in blood sugar can help manage certain ADHD symptoms like hyperactivity, impulsivity and concentration.
This can be done by eating consistently throughout the day, by focusing on complex carbohydrates and by having protein with carbohydrate-containing meals and snacks.
Complex carbohydrates contain starch and fiber, which can slow down blood sugar, help you feel full longer and alleviate constipation (yay!). Simple carbohydrates, on the other hand, are usually made up of more simple or refined sugars. If eaten on their own, simple carbohydrates are more likely to lead to imbalances in blood sugar.
Foods high in complex carbohydrates:
- Fruits
- Vegetables
- Beans and lentils
- Whole grains products, like bread and pasta
- Oats, buckwheat, quinoa and rice
Fat
Fat helps protect your organs and absorb fat-soluble vitamins from your diet. Your brain is also made of fatty tissues. To best maintain its processes, you need healthy fats every day.
Foods high in healthy fat:
- Fatty fish like tuna, salmon and sardines
- Nuts and nut butters
- Avocados
- Seeds like hemp, chia and flax seeds
- Oils like olive oil
Some foods contain essential fatty acids, which means they cannot be made by your body like certain other nutrients. You need to get these from your diet or a supplement. One of these essential fatty acids is omega 3, which provides some benefits to people with ADHD.
Micronutrients
Nutrient deficiencies have been linked to an increase in ADHD symptoms. Certain micronutrients are more important than others when it comes to ADHD nutrition.
Omega 3 fatty acids
Omega-3 Fatty Acids are one of the most well studied nutrients related to ADHD. Omega 3 fatty acids help create hormones that assist with blood circulation in the brain and body. They are essential fatty acids, meaning that they are not made by your body. You therefore need to get these fats from food or supplementation. We typically see decreased plasma levels in those with ADHD. EPA regulates serotonin release while DHA regulates serotonin receptor function – differing and complementary actions. Recent studies have shown that omega-3 supplementation with methylphenidate (common ADHD medication) increased the benefit over methylphenidate alone. Ensure you’re choosing a supplement with both EPA and DHA (Nordic Naturals)
Foods high in omega-3:
- Fatty fish like tuna, salmon and sardines
- Seeds like chia and flax seeds
- Walnuts
Vitamin D
Vitamin D is important for brain and bone development as it helps the body absorb calcium and phosphorus. Children and adults with ADHD often have lower levels of vitamin D in their blood.
Vitamin D supplementation has been shown to improve inattention, hyperactivity, and impulsivity.
Foods high in vitamin D:
- Fish like salmon, tuna and sardines
- Egg yolks
- Mushrooms
- Not a food, but sunshine
- Vitamin D-fortified foods like dairy, orange juice and cereal
Magnesium
Magnesium is essential for energy production and it helps enzymes within the nerves and muscles carry out their function. It allows for muscles to relax, increasing blood flow and providing a sense of calm.
Magnesium deficiency is linked to more hyperactivity and impulsivity.
Foods high in magnesium:
- Seafood
- Whole grains
- Nuts and seeds
- Beans
- Dark leafy greens
Zinc
Zinc helps enzymes in the body carry out their functions. It helps with the development of DNA, other cells and protein. It also plays a role in your metabolism and immunity.
For ADHDers, zinc is important since it improves the brain’s response to dopamine. Deficiencies often result in symptoms of inattention.
Foods high in zinc:
- Meat, like beef and pork
- Beans and lentils
- Nuts and seeds
- Eggs
- Dairy
- Whole grains
- Zinc-fortified products
Iron
Iron helps carry the oxygen in our blood to all areas of the body. Cognitive deficits and other ADHD symptoms have been linked to low levels of iron. Unfortunately, iron deficiencies are common in the ADHD population.
Foods high in iron:
- Meat like poultry, beef and pork
- Beans and tofu
- Dark leafy greens
- Iron-fortified products like bread, cereal and pasta
Your diet for ADHD will look different than it does for someone else. Here is a list of items you may want to consider avoiding if they impact you:
Foods and ingredients you are allergic or intolerant to. These might include:
- Specific foods
- Caffeine
- Artificial sweeteners
- Food coloring or flavoring
- Food preservatives like nitrates, sulfates or MSG
- Foods that spike blood sugar. Avoiding spikes and dips in blood sugar can help with focus, energy and behavioral symptoms. Pairing foods higher in sugar with protein and fiber can help.
- Foods that trigger sensory issues. If you don’t like the texture of something, that’s okay. No need to force it. There are a lot of edible options out there.
- Foods you don’t like
Movement and Behavioral Strategies
This conversation would not be complete without discussing the benefits of movement (especially for our clients with hyperactive symptoms) and behavioral strategies. We hear from our clients that they often feel like they are being driven by a motor, they feel restless, and often have a hard time relaxing or turning off their brain and body at the end of the day. Movement can not only help relieve the feelings of restlessness, but can also increase the transport of tryptophan across the blood brain barrier. Optimal tryptophan levels support behavior in terms of sustained attention as well as behavioral inhibition (impulse control) in adults and children with ADHD. Exercise also increases serotonin production as well as the brain derived neurotrophic factor (BDNF) both of which are required for learning and memory as well as mood regulation.
This could be as simple as getting your wiggles out by dancing around your kitchen to your favorite pick me up song, running up and down the stairs to help break up “boring” tasks or formal exercise such as participating in sports, cardio and strength training. Any amount helps!
Behavioral Strategies for ADHD
- Focus on the positive – the way you do something like meal prep, or your morning routine might not look like everyone else and if it’s working well for you, that’s a WIN!
- Allow for autonomy when possible – forcing yourself in an overly rigid or restrictive plan, food or schedule-wise might backfire with kids and adults alike. We need opportunities for autonomy, otherwise individuals are much more likely to rebel against the plan.
- Build healthy habits to last a lifetime – work with your team to create a sustainable plan for life rather than an overly intensive plan that you can only maintain for a week or two. Benefits come from things you do most of the time, rather than only once in a while.
- Establish routines and expectations – this is just as important for kids as is for adults. Creating and maintaining routines can be especially challenging for those with ADHD – my clients often share they tend to intensely rebel against routines! Working together with your care team to design a routine that helps you get your needs met, includes a balance of dopamine boosting activities and behaviors, and helps you live a life that upholds your values.
- Make the healthy choice the easy choice – this often involves creating an environment that supports the habits you want to show up to whether it’s getting to bed on time or choosing foods that will support your needs and balanced blood sugars working together with your care team can be integral to your success.
- Build awareness when you’re using food as a distraction or a stimulating source of dopamine. Mindless eating and binge eating behaviors are very common among those with ADHD. Eating and snacking can provide such a boost in dopamine so building awareness and understanding is key to addressing and ultimately changing this behavior is paramount. Ensuring optimal dopamine production through blood sugar management and balanced nutrition is key to putting you back in the driver’s seat!
If you or someone you love is struggling with ADHD, or you’d just like to learn more, we’d love to support you. Reach out today to schedule an appointment with one of our nutrition providers – we may be able to help!
Author – Riana Giusti, MS, CN
References:
ADHD Symptoms Increased During COVID-19 Pandemic
Trends in the Prevalence and Incidence of Attention-Deficit/Hyperactivity Disorder Among Adults
https://www.todaysdietitian.com/newarchives/0323p44.shtml
https://www.sciencedirect.com/science/article/pii/S2772566922000210
https://psychcentral.com/adhd/adhd-diet
Micronutrients and Diets in the Treatment of ADHD
Nutrition in the Management of ADHD: A Review of Recent Research
Eating Patterns and Dietary Interventions in ADHD: A Narrative Review
https://www.idealnutrition.com.au/nutrition-for-adhd-a-dietitians-guide/