I recently gave a talk on Attention Deficit Hyperactive Disorder and diet. This was a challenge for me for two reasons: one, I knew very little about the links between diet and ADHD, and two, I assumed (correctly!) that most parents of children with ADHD have already done a great deal of self-education research on the subject of ADHD and diet.

Here is what I learned, and these are my talking notes…

Healthy eating is important for all of us, and is especially important for individuals with chronic health conditions.

When it comes to Attention Deficit and Hyperactive Disorder, there has been and continues to be controversy over the influence of diet and ADHD symptoms.

Now let me clarify, I am speaking about dietary factors that may affect the symptoms associated with ADHD, and in no way am I implying that dietary factors cause ADHD, nor am I claiming dietary changes can cure ADHD. I will leave that to the experts and the clinical researchers.

However, I do firmly believe that striving for healthy eating carries little harm. And, there are many potential benefits. We would all do well to become more aware of the foods we consume, what things are added to our foods, and how the food choices we make impact both the immediate and long-term health of ourselves and our families.

I am going to review some nutritional strategies that are being examined to help reduce the symptoms of ADHD. Please keep in mind as we are covering these strategies that it would be best to consider making one or two small changes, monitoring for improvement, and then working to make those dietary changes become permanent lifestyle changes. Trying to do too much, too soon will, in my counseling experience, lead to failure. In addition, making too many changes at one time will make if difficult if not impossible to determine which of the changes were successful at reducing symptoms.

Food and Nutritional concerns relating to ADHD have focused on:

• Food additives including both food dyes and preservatives,
• sugar intake
• protein intake
• food allergies and intolerances
• Nutrient deficiencies including vitamin, mineral and fatty acid deficiencies

The majority of the research on ADHD and diet over the past 40 years has focused on the food additives, especially the artificial dyes used in our foods.

Some interesting statistics available from the Food and Drug Administration (FDA) about food dye production in the United States:

• Food dye production in 1955 averaged out to about 12 mg per individual
• This increased to 32 mg in 1975
• And increased again to 47 mg in 1998
• This is a fourfold increase in just 40 years

And consider the amount of foods and beverage that are now marketed specifically to children and that the majority of these are brightly colored and highly processed.

And what about sugar consumption?

Do you know how much sugar an average American is consuming per year? When I say “added sugar” I am talking specifically about sugars that are not naturally present in our foods. These are the sugars that are added to our cookies, cakes, ice creams, candies, and beverages.

• We currently are consuming 156 pounds of added sugar, per person, per year
• The majority of this added sugar – 33% of it, comes from soft drinks
• 26% of it comes from commercially prepared foods
• 10% from fruit drinks

Because today’s children are consuming far larger quantities of sugar than previous generations, there has been speculation about the impact of this sugar consumption on ADHD.

Most of the evidence linking sugar consumption to behavior changes in children, especially children with ADHD is anecdotal, that is, it has come from observation. In other words, a child consumes a high-sugar food or beverage, and the parent/teacher or other care-giver notices a distinctive change in the child’s behavior.

There has not been much research into sugar and symptoms of ADHD, and the research that has been conducted has been criticized for poor design.  

However, I would like to suggest that a high sugar containing diet provides too many empty calories, and replaces nutritious food choices.

So, what to do?

• Eliminate high sugar foods and beverages – they should be consumed occasionally and be considered special treats
• Read labels. When looking at a label, avoid the sneaky sugars such as corn syrup, high fructose corn syrup, sucrose, dextrose, and fructose. These are all naturally occurring sugars, but are now added in quantity to our foods and beverages
• Remember that the list of ingredients starts with the items in greater quantity. The closer to the top of the list the sugar, the more the product contains
• And don’t forget to consider serving sizes. This 20-ounce bottle of Sunkist lists 2.5 servings per bottle. How many people only drink 1/3 of the bottle?

PROTEIN

I want to mention protein here. There has been some research conducted on protein intake and ADHD symptoms.

The brain makes a variety of chemical messengers, or neurotransmitters, to regulate wakefulness and sleep. Studies by Massachusetts Institute of Technology researchers and others have shown that protein triggers alertness-inducing neurotransmitters, while carbohydrates trigger drowsiness.

These findings support the popular belief that people with ADHD do better on a protein-rich breakfast and lunch.

Children’s foods are often highly processed carbohydrates. By eliminating or reducing these foods and adding small amounts of healthy proteins, there may be an improvement in symptoms.

• Protein sources include eggs, cheese, nuts and nut butters, cottage cheese as well as meats.
• Avoid or limit processed meats such as lunch meats and sausages as these contain added chemicals.
• A serving of peanut butter is about the size of your thumb; 1/3 cup cottage cheese; one egg; one ounce of cheese; one to two ounces of meats.

ELIMINATION DIETS

Recent studies suggest that sensitivities to certain foods may worsen symptoms of ADHD in children.

Most frequently eliminated foods include:

• milk and dairy
• wheat products
• soy
• nuts
• fish
• specific fruits such as strawberries and peaches
• foods with dyes and other additives (I will discuss specific food additives shortly).

After you have eliminated the suspected foods for two weeks, you begin to restore them, one at a time, to see whether they cause a reaction. Keeping a journal of foods and symptoms is extremely helpful during this time.

Caution should be used when eliminating foods. Children especially are growing at a rapid rate and need a variety of foods to obtain all the necessary vitamins and minerals for good health. Working with your doctor or a registered dietitian is the safest way to insure your child’s diet is adequate.

Elimination diets have had mixed results in scientific studies of ADHD. The most recent study was published in the Lancet this past winter.

The study looked at a limited diet that focused on a few selected foods including rice, meat, and vegetables.  

“After five weeks, 64% of those on a restricted diet had significant improvement in symptoms; no improvement was seen in those who were not on the restricted diet,” Lidy Pelsser, MD, of the ADHD Research Center in Eindhoven, the Netherlands, and colleagues reported in The Lancet.

“We think that dietary intervention should be considered in all children with ADHD, provided parents are willing to follow a diagnostic restricted elimination diet for a five-week period, and provided expert supervision is available,” they wrote.

A total of 100 children were enrolled; most were boys and the average age was 7.

The most famous elimination diet is known as the Feingold diet. I wanted to mention this, because many of you will have heard of it. I personally know of some parents who follow it for their non-ADHD children, simply believing it is the safest and healthiest way to feed their family.

FEINGOLD DIET

 (http://www.webmd.com/add-adhd/news/20040524/food-additives-may-affect-kids-hyperactivity)

The idea that food could have an effect on children’s behavior became popularized in the 1970s by allergist Benjamin Feingold, MD, who published the Feingold diet. He advocated a diet free of more than 300 food additives to treat hyperactivity.

He accidently came to this conclusion when treating children with allergic symptoms including rashes and eczema. When the diet was changed and food additives were removed, the children’s allergy symptoms improved as well as their behavior.

The Feingold diet is probably one of the most controversial and criticized of the dietary approaches.

According to the Mayo Clinic, some of the food additives suspected of increasing behavior problems in children, especially children with ADHD:

http://www.mayoclinic.com/health/adhd/AN01721

• Sodium Benzoate
• FD&C Yellow No. 6
• FD&C Yellow No. 10
• FD&C Yellow No. 5
• FD&C Red No. 40

The most widely used coloring is the Red # 40. According to the Center for Science in the Public Interest, the safety testing on this color has been poorly conducted.

Yellow # 6 is the third most widely used coloring and studies have shown tumors of the adrenal glands and kidneys.

FD&C Yellow # 5, used in beverages, candy, ice cream, custards and other foods, may be more likely to cause reactions than other additives. The Food and Drug Administration requires that Yellow # 5 be clearly labeled on food packaging along with other ingredients. But many colorings and food additives don’t require labeling, so it can be difficult to tell whether a food contains artificial coloring or other additives.

In light of research in Great Britain and pressure from their FSA (equivalent to our FDA), food manufacturers and providers have eliminated many food colorings that were indicated to cause problems for children. 

Some of Britain’s biggest supermarket chains—Tesco, Sainsbury’s, ASDA, Marks & Spencer, and the Co-op—have pledged to drop the dyes from their house-brand products. Mars candies promised to eliminate the studied additives from its confectionaries in Britain by the end of 2008, but not in the United States.

Dyes are also absent from McDonald’s, Nestlé, Kraft, and Kellogg foods in Britain, but not in the United States. Why are the food manufacturers making significant changes in Britain but not in the United States? Are we being too complacent?

 NUTRITIONAL DEFICIENCIES

Another area of nutritional intervention that is being examined is suspected nutritional deficiencies and ADHD symptoms. The idea is that not getting the proper balance of vitamins, minerals, and other nutrients can make some children more susceptible to the symptoms of ADHD.

Currently, research is looking at the balance of omega-3 and omega-6 fats that we consume. A lot of our processed foods have added fats that are high in omega-6 fatty acids and we are not consuming enough of the foods that are naturally high in omega-3 fatty acids such as walnuts, flaxseed and fish.

Nutritional interventions would include:

• Reducing highly processed foods that have added fats (these added fats are typically the unhealthy trans fats as well as high in omega-6 fatty acids)
• Consuming more foods with omega-3 fatty acids such as walnuts, flax seeds, and fish

IN SUMMARY:

• Start with 1 or 2 small goals to work with
• Reduce high sugar foods and beverages

These should be considered treats and for special occasions

• Read labels for sugars, additives, and serving sizes
• Provide small portions of healthy proteins with breakfast and lunch
• Consider food sensitivities:
• Keep a journal
• Eliminate one suspected food at a time for several weeks
• Monitor symptoms and add food back
• Include some high omega-3 fatty acids foods in your weekly meals and snacks

Healthy eating for all of us should be focused on real foods – the less processed the better. As food author Michael Pollan says, our food should be recognizable by our grandparents. In other words, bright green Gogurt in a tube does not count as “food”!

 RESOURCES:

Center for Science in the Public Interest:

One of their primary goals is to make sure that science and technology are used for the public good.

http://www.cspinet.org/reports/chemcuisine.htm

 They have an excellent resource on food additives and safety on their website:

http://www.cspinet.org/reports/chemcuisine.htm

WebMD article: Food Additives May Affect Kid’s Hyperactivity:

http://www.webmd.com/add-adhd/news/20040524/food-additives-may-affect-kids-hyperactivity

Mayo Clinic: ADHD diet; Do Food additives cause hyperactivity?:

http://www.mayoclinic.com/health/adhd/AN01721