Nutrition, Lifestyle, & ADHD
ADHD is the most common neurodevelopmental disorder diagnosed in childhood, with 10% of US children carrying the diagnosis. Eight million adults have the disorder, with only one in five treated.
Abnormal dopamine metabolism has been implicated in the etiology of ADHD. Dopamine is intimately involved in cognitive control in the prefrontal cortex, as well as motivation, choice, and value-based learning in the striatum. Medications to treat ADHD increase dopamine and norepinephrine levels in the brain, as well as influence other neurotransmitter systems (serotonin and glutamate).
ADHD is a genetic, neurological, nutritional, and environmental disorder, in which an imbalanced brain triggers imbalanced behavior. There is no single cause of ADHD. Rather, multiple factors can trigger symptoms.
Genetics
· Fifty percent of parents with a child with ADHD have the disorder.
· Seventy-five percent of those diagnosed with ADHD have genetic drivers.
· The main genes involved control dopamine and norepinephrine, neurotransmitters that regulate attention, ability to focus, and pleasurable sense of reward.
Neurological
· Children with ADHD have brains that develop differently.
· The areas of the brain which control attention, executive function, the ability to plan, and impulsivity lag developmentally by roughly 2 to 3 years.
· These areas are also less metabolically active.
· Children with ADHD have more theta brain waves. These waves are more prominent when daydreaming and sleeping.
Environmental
· ADHD is more prevalent in urban areas.
· Air pollution raises the risk of having a child with ADHD.
· Lower socioeconomic classes are twice as likely to have children with ADHD.
· Children with higher urinary levels of the toxin BPA (from plastics) are more likely to be diagnosed with ADHD.
· American children have higher rates of ADHD.
Nutritional
Nutrition can play a significant role in managing the symptoms of ADHD. While nutrition alone cannot cure ADHD, it can have a positive impact on overall health and potentially help reduce some symptoms. A well-nourished brain is a well-balanced brain.
1. Balanced Diet: A diet rich in fruits, vegetables, whole grains, lean protein, and healthy fats can support cognitive function and overall health.
2. Omega-3 Fatty Acids: Omega-3 fatty acids, found in fatty fish like salmon, walnuts, and flaxseeds, have been studied for their potential to improve attention and focus in individuals with ADHD.
3. Protein: Including an adequate amount of protein in the diet can help regulate blood sugar levels and provide a steady supply of energy. Protein-rich foods like tofu, lean meats, poultry, fish, eggs, and legumes can be beneficial.
4. Avoiding Sugar and Processed Foods: Some studies have suggested a link between high-sugar diets and increased hyperactivity in children with ADHD. It's a good idea to limit the consumption of sugary foods and drinks and avoid highly processed foods that often contain artificial additives and preservatives.
5. Micronutrients: Deficiencies in certain vitamins and minerals, such as zinc, iron, magnesium, and B-vitamins, have been associated with ADHD symptoms.
Magnesium-rich foods: Nuts, dark chocolate, whole grains, beans, & green leafy vegetables.
Zinc-rich foods: seafood, chicken, cheese, whole grains, fortified cereals, beans, & nuts.
6. Food Sensitivities: Some individuals with ADHD may be sensitive to certain foods or food additives.
Casein from dairy becomes casomorphin when broken down in the body. Gluten becomes gliadorphin. Both are morphine-like compounds. High levels can be seen in individuals who have genetic changes in their dipeptidyl peptidase IV (DPP-IV) enzyme structure. This enzyme breaks down both casein and gluten. A zinc deficiency can also alter DPP-IV enzyme function.
Roughly 8% of children with ADHD will have symptoms related to synthetic food colors.
7. Hydration: Dehydration can affect cognitive function and concentration.
8. Meal Timing: Regular balanced meals and snacks spaced throughout the day can help maintain stable blood sugar levels, which can have a positive impact on mood and focus.
Supplements are often considered as a complementary approach to managing ADHD symptoms. Supplements that have been explored for ADHD include:
Omega-3 Fatty Acids: The brain is dependent on the essential omega-3 fatty acids, EPA and DHA. Almost every aspect of neurotransmission controlling thought, emotion, and action, are reliant on omega 3s. Supplementation with omega-3 fatty acids has been shown to improve hyperactivity, attention, memory, sleep, and learning.
Oligomeric Proanthocyanidins (OPCs): OPCs are powerful plant pigments that can alter brain waves. They also regulate
-levels of norepinephrine & epinephrine
-limit the production of glutamate (an excitatory neurotransmitter)
-slow the production & release of histamine
-protect brain cells from damage
-strengthen the blood-brain barrier
-improve blood flow to the brain
-decrease inflammation
-absorb harmful metals
Examples of OPCs include pine bark, green tea, grape, and blueberry extracts. Ounce for ounce, dark chocolate delivers more brain balancing OPCs than any other food.
Zinc: Zinc is essential for the proper operation of all cells in the body and in manufacturing proteins, including neurotransmitters.
-Zinc nourishes the entire brain and helps protect it from damage.
-Zinc deficiency can decrease the effectiveness of ADHD medications.
-Zinc improves hyperactivity, inattention, and brain waves.
It is important to ensure an appropriate zinc/copper balance in the body.
Magnesium: Nine out of ten children with ADHD have magnesium deficiency. The use of ADHD stimulant drugs can also result in magnesium deficiency.
-Magnesium plays a role in more than 300 cellular reactions.
-This includes those that are involved in energy production and blood sugar control. Magnesium also plays a key role in the formation of neurotransmitters.
-Magnesium deficiency can result in irritability, poor focus, sleep problems, mood swings, fatigue, and anxiety.
When taken together, vitamin B6 increases cellular uptake and limits excretion of magnesium.
Iron: Iron deficiency has been associated with ADHD-like symptoms, especially in children. Iron deficient children score poorly in math and language tests.
Children with iron deficiency have a 67% higher risk of developing ADHD.
Iron deficiency is also linked to sleep disorders, low IQ, depression, and anxiety.
Folate: Folate helps convert tyrosine to dopamine.
Vitamin B6 and B12: These B-vitamins are involved in neurotransmitter synthesis and brain function.
L-theanine: L-theanine is an amino acid found in tea leaves, and it's known for its calming effects.
Multivitamin: Taking a well-balanced multivitamin can help ensure that individuals with ADHD receive all the essential vitamins and minerals needed for overall health and brain function.
Vitamin D: Vitamin D is involved in neurotransmitter production, neuroprotection, cognitive function, brain development, and mood.
Probiotics: Learn more below about ADHD and the gut microbiome.
Saffron: Saffron is a spice derived from the flower of Crocus sativus. It contains compounds with antioxidant and anti-inflammatory properties. These properties are associated with potential neuroprotective effect. Some studies also suggest saffron may have mood-improving properties.
Herbal Supplements: Some herbal supplements, such as ginkgo biloba, Rhodiola rosea, and ginseng, have been studied for their potential cognitive-enhancing effects.
It's crucial to approach supplements for ADHD with caution:
· Always consult with a healthcare provider before starting any supplement regimen, as they can help determine if supplementation is appropriate based on an individual's specific needs and health status. Individual responses to supplements can vary, and what works for one person may not work for another.
Supplements are best considered as part of a comprehensive treatment plan that may include medication, behavioral therapy, and lifestyle modifications.
Ensure that the supplements are of high quality and purchased from reputable sources to minimize the risk of contamination or ineffective products.
Adopting certain lifestyle strategies can complement these interventions and improve overall well-being for individuals with ADHD.
1. Regular Exercise
2. Adequate Sleep
3. Mindfulness and Meditation
4. Limit Screen Time
5. Stress Reduction Techniques
6. Limit Toxin Exposure
7. Social Support
8. Neurofeedback Therapy
ADHD & the Gut Microbiome
The gut microbiota interact with the brain through a bidirectional communication system called the gut-brain axis. This communication pathway plays an important role in mood, various neurologic disorders, and stress. The gut-brain-microbiome axis has been implicated in the development and severity of ADHD.
Individuals with ADHD may have lower levels, as well as less diversity, of beneficial gut microbiota. In addition, particular strains may be increased and may contribute to the etiology of ADHD.
Neurodevelopment, as well as establishment of the adult gut microbiome, occur within the first few years of life, each affecting the growth and maturation of the other. Bacterial colonization of the gut begins in utero. Premature infants, as well as those born via Cesarean section, are at higher risk of both gut dysbiosis and ADHD. Other risk factors associated with gut dysbiosis and ADHD include perinatal maternal smoking, stress, formula feeding, sleep disturbance resulting in disruption of the normal Circadian rhythm, and early life antibiotic use.
Neurotransmitter dysfunction, seen in ADHD, can lead to neuronal (brain cells that transmit nerve impulses) inflammation and oxidative stress. Unhealthy gut microbiota may worsen neuroinflammation via interaction with microglia (brain cells involved in repair), decreased production of short chain fatty acids (healthful bacterial metabolites), and alteration of omega-3 fatty acid metabolism.
Decreased dopamine in the gut is also associated with increased production of proinflammatory markers and decreased Treg cells (immune cells involved in preventing autoimmunity and regulating the immune response).
Available levels of dopamine are influenced by gut bacteria either by expression of genes involved in production of neurotransmitters or alteration of neurotransmitter metabolic pathways.
HPHPA is a metabolite of the amino acid tyrosine. It is produced as a metabolic byproduct of certain bacteria, in particular Clostridia, in the gut. Individuals with ADHD have higher levels of HPHPA in their urine. HPHPA is thought to interfere with the breakdown of dopamine, leading to increased levels.
Bifidobacterium, which has been found to be increased in individuals with ADHD, increase production of cyclohexadienyl dehydratase (CDT). High levels of CDT correlate with altered anticipation responses. In a double-blind placebo-controlled trial, individuals with ADHD that were given micronutrient supplementation (antioxidants, minerals, vitamins) were noted to have decreased levels of Bifidobacterium in their feces after a 10-week supplementation period, as well as improved cognitive function scores.
Gut microbiome dysfunction (dysbiosis) also results in alteration of the circadian rhythm. Sleep disorders are extremely common (70%) in individuals with ADHD.
Strengthening the gut microbiome and its diversity will decrease neuroinflammation, improve neurotransmitter production, and help the gut-brain-microbiome axis. This involves increasing consumption of foods rich in fiber, complex carbohydrates, prebiotics (fermented foods), probiotics, legumes, nuts, seeds, and omega-3 fatty acids, while decreasing foods high in simple sugars and saturated fat. This dietary pattern is exemplified in the Mediterranean diet. Mediterranean diets have been associated with improved gut diversity as well as decreased ADHD diagnosis.
Diets high in simple sugars, on the other hand, are positively correlated with ADHD.
A healthy gut microbiome is also reinforced by exercise, decreased stress, and good quality sleep.