The role of Nutrition in supporting ADHD

ADHD for many families is a personal experience, navigating through the diagnosis, the questions, the lack of resources available and sometimes often guilt.

But with ADHD, there doesn’t seem to be many answers to all the questions that parents have around it…is there something we can do to help our child? Is it something that we have done? Are drugs our only option? Will this impact on them when they are adults? How do we cope?

Attention deficit/hyperactivity disorder (ADHD) is among the most common neurobehavioral disorders in children and adolescents and the numbers being diagnosed is increasing.

It appears as inattention, impulsivity and hyperactivity with symptoms ranging from anxiety, mood, disruptiveness, oppositional defiant disorder (ODD), conduct disorder and some antisocial disorders. ADHD is estimated to be three times more common in boys than in girls.

It has long been treated with ADHD drugs which has, in itself, concerns regarding adverse effects. So what are the options? 

Diet may play a relevant role in the progression of ADHD. In fact many studies have shown that children with ADHD have varying levels of many important nutrients than children that do not present with ADHD.

Many of the children we see in our clinic who have been diagnosed with ADHD appear to have very differing dietary patterns compared with children who do not have ADHD. Food aversions are very common with many parents describing their child’s diet as beige, children often show reluctance to eat more than maybe a few different foods.

Recent studies have shown a significant link between ADHD and an abnormal dietary pattern such as the consumption of “junk food” and non-adherence to a “traditional” three-meal daily diet and instead aversions to many traditional foods.  The studies showed that many of the children’s diets had a considerably higher intake of fat, sugar, and more processed foods and lower intake of omega-3 fatty acids, fibre, and many vital micronutrients. A link has therefore been shown between food aversion and ADHD.

With more and more research focusing on the development of ADHD, there’s been more evidence surrounding the effects of nutritional deficiencies, and nutritional interventions to help support children with ADHD and the subsequent comorbidities.

Mounting evidence has shown a significant link between gut health and brain health in children with ADHD. Studies suggest that the bidirectional relationship between the gut microbiome and the central nervous system known as the microbiome–gut–brain axis plays a very influential role in the progression of ADHD. So what does that mean?

The gut plays a big role in our health. In fact the bacteria present in our gut known as gut microbiome has many roles within the body including the metabolism and absorption of nutrients, including carbohydrates and proteins, bile acid, vitamins and other bioactive compounds, as well as the impact on brain development, the immune, and neuroendocrine systems which are all imperative for the normal functioning of our body and many aspects that are involved in symptoms
associated with ADHD.

Diet, lifestyle and modern life can impact how our microbiome functions and its diversity. This is also evident from as early as birth as Caesarean births can impact and influence the composition of the commensal microbiome.

The gut microbiome can impact on the generation of neurotransmitters, by synthesizing them or by influencing the neurotransmitter-related metabolism pathways e.g. dopamine, serotonin, and other neurotransmitters, such as glutamate and gamma-aminobutyric acid (GABA). One way it does this is the gut microbiome influences dopamine within the brain, and disruptions in dopaminergic and serotonergic systems within the brain have been associated with the appearance of mood-related disorders and cognitive functions including ADHD.

The gut microbiome also influences the neuroendocrine system by modulating the secretion of gastrointestinal peptides that help to mediate metabolic functions related to energy homeostasis, such as insulin, leptin, ghrelin, neuropeptide Y family (NPY) and glucagon-like-peptide 1 (GLP-1). These are often related to hunger, hunger suppression and eating. Therefore the gut microbiome exerts an influence on these hormones and can influence food choices and how much or little a child
will eat.

The intestinal microbiome produces short-chain fatty acids (SCFAs), particularly butyrate, propionic acid and acetate, this is done by the degradation of fibre rich foods. Short chain fatty acids are vital for the health of the gut lining and colon health but also exerts an anti-inflammatory effect with inflammation often seen in children with ADHD. One type of SCFA known as Butyrate has anti-inflammatory properties, it actually induces the release of the anti-inflammatory IL-10 and inhibits
proinflammatory cytokines (IL-6, IL-12). These pro-inflammatory cytokines can increase inflammation within the body, particularly in the brain.

Have you found that your child seems to be reacting to lots of different foods?

Food sensitivities are complex non-allergic inflammatory reactions which can involve both innate and adaptive immune pathways. These food reactions prompt the immune system to create an internal inflammatory response. These mechanisms trigger reactions in white cells leading to the release of proinflammatory and proalgesic mediators, such as cytokines, leukotrienes, and prostaglandins.  These can impact on mood, digestive issues and even skin conditions.

Many studies have shown that children displaying symptoms of ADHD also develop symptoms of diarrhoea, stomach pain and bloating which are characteristics of microbiome imbalance, increased inflammation and even gut permeability. One way we can support children is to work at supporting the gut, gut microbiome and improve its function. This is something we see commonly in clinical practice.

Remember the gut microbiome plays a role in nutrient absorption, and with disruptions in microbiome diversity this can impact on the nutrients being absorbed. Gut healing can greatly improve nutritional status and has been shown to greatly improve many symptoms associated with ADHD including concentration, impulsiveness, mood and behaviour.
 
Omega 3 Fatty acids are key regulators of brain neurotransmission, neurogenesis, and neuroinflammation, all having an important role in the prevention and treatment of psychological and behavioural dysfunction disorders. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are the two fatty acids that are highly concentrated in the brain, which exhibit antioxidative, anti- inflammatory, and antiapoptotic effects, contributing to neuron protection within the brain. Our
brain is predominantly made of 60% fats and low levels of beneficial fats including omega 3 can have a negative effect on how it functions from concentration, anxiety, moods, reactions, and learning.

Low levels of omega 3 have been shown to alter dopaminergic and serotonergic systems, modifying certain receptors in the brain resulting in symptoms associated with ADHD.  Including omega 3 rich foods such as oily fish and eggs is a great way to increase omega 3 intake.  Walnuts and chia seeds provide omega 3 in the form of ALA which has to be converted within the body to EPA and DHA therefore sources of EPA and DHA are much more bioavailable for the use within the body. Try to opt for good forms of EPA and DHA and combine with Vitamin E rich foods to aid absorption such as nuts and seeds, peppers, leafy greens.

We see many clients that try omega 3 and see no results and stop taking them but it needs to be introduced with other factors to provide a therapeutic effect. You see many studies have shown that there are several nutrients that are deficient with children that are diagnosed with ADHD which are vital for brain health so combining omega 3 with other therapeutic nutrients will have more effect than by itself.
   
Children with ADHD have been shown to have lower levels of dopamine and may lack the neurotransmitter noradrenaline. Magnesium is crucial for brain activity and the dopaminergic system. It affects the function and binding of neurotransmitters such as dopamine and serotonin. magnesium can actually increase neurotransmission by endogenous serotonin receptors as well as
supporting the calming actions of GABA by interacting with its receptor. Studies have shown that Magnesium supplementation with the addition of vitamin B 6 , which increases magnesium absorption, have shown promise for reducing ADHD symptoms. Encourage consumption of magnesium-rich foods such as bananas, avocados, beans, leafy green vegetables, Dark chocolate, nuts/seeds, wholegrains such as oats, quinoa and buckwheat, legumes.
There are many different forms of magnesium supplements with some  that are poorly absorbed and can cause laxative effects. Therefore, it is advisable to speak to a  Nutritional Therapist or health professional before introducing a magnesium supplement particularly for ADHD.
 
Zinc is another nutrient that is beneficial for ADHD. Zinc is essential factor in the metabolism of neurotransmitters, prostaglandins, and for maintaining brain structure and function. It is often low in children with ADHD. Dopamine is one of the most important factors in the pathophysiology of ADHD, and melatonin helps to regulate dopamine. Zinc is involved in melatonin production which modulates the function of dopamine and dopamine signalling, therefore is an important factor in
reducing symptoms of hyperactivity. Food’s rich in zinc include seafood, nuts, seeds particularly pumpkin seeds, beans, and nuts. 

Vitamin D is not only important for gut health but also vitamin D is a neuroactive steroid that has been shown to be important for normal brain development and neurodevelopment. Vitamin D also has an effect on dopamine pathways. In the UK we don’t get as much sun exposure and we often find children and adults with low levels, particularly in ADHD. Dietary sources of vitamin D include fatty fish, eggs, butter, liver and mushrooms but it is advisable to include a vitamin D supplement. It
is always advisable to get vitamin D levels checked to ensure adequate intake through supplementation which will determine whether there is a therapeutic effect.

Most of these nutrients by themselves will not provide the sufficient effect and need to be combined with a well balanced diet and beneficial cofactor supplementation. If you would like to know more or would like to book a consultation to discuss your child’s symptoms, then please do get in touch. We provide support for you and your child with the best possible guidance and support to help to improve your child’s overall health and the symptoms of ADHD.

To find out more about how we work with children or to book an appointment click here. 

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2. Lange, K., 2020. Micronutrients and Diets in the Treatment of Attention-Deficit/Hyperactivity Disorder: Chances and Pitfalls. Frontiers in Psychiatry, 11.
3. Derbyshire, E., 2017. Do Omega-3/6 Fatty Acids Have a Therapeutic Role in Children and Young People with ADHD?. Journal of Lipids, 2017, pp.1-9.
4. Lepping, P. and Huber, M., 2010. Role of Zinc in the Pathogenesis of Attention-Deficit Hyperactivity Disorder. CNS Drugs, p.1.
5. Villagomez, A. and Ramtekkar, U., 2014. Iron, Magnesium, Vitamin D, and Zinc Deficiencies in Children Presenting with Symptoms of Attention-Deficit/Hyperactivity Disorder. Children, 1(3), pp.261-279.