Studies show that a high-protein, low-sugar, no-additive diet combined with ADHD-friendly supplements like fish oil and zinc can drastically improve ADHD symptoms in children with no side effects. Here, an ADHD specialist tells you how to get started.
by Sandy Newmark, M.D.
Good nutrition can make a significant difference in the lives of children who have been diagnosed with attention deficit disorder (ADD/ADHD).
I have used nutritional interventions for hundreds of children with ADHD during the past 24 years. In many cases, dietary changes have not only improved the symptoms of hyperactivity, concentration, and impulsivity, but also have calmed oppositional behavior.
Many parents are eager to try foods and supplements to help their kids manage ADHD symptoms, but they often don’t know where to start. Below are several dietary changes — food to add to your child’s diet, things to eliminate — that, I have found, deliver the most symptom relief.
Stop Blood Sugar Spikes
Foods rich in protein — lean beef, pork, poultry, fish, eggs, beans, nuts, soy, and low-fat dairy products — may have beneficial effects on ADD symptoms.
Protein-rich foods are used by the brain to make neurotransmitters, the chemicals released by brain cells to communicate with each other. Protein can prevent surges in blood sugar, which increase hyperactivity. Giving your child protein for breakfast will help his body produce brain-awakening neurotransmitters.
Combining protein with complex carbs that are high in fiber and low in sugar will help your child manage ADHD symptoms better during the day, whether he’s taking medication or not. The single most important thing I recommend to parents is to decrease the amount of sugar in their ADHD child’s diet.
What many people don’t know is that eating simple processed carbohydrates, like white bread or waffles, is almost the same as feeding your child sugar! Your body digests these processed carbs into glucose (sugar) so quickly that the effect is virtually the same as eating sugar from a spoon.
A breakfast consisting of a Pop-Tart and a glass of juice, or a waffle with syrup, causes blood sugar to rise quickly. The body responds by producing insulin and other hormones that drive sugar down to too-low levels, causing the release of stress hormones. The result? By mid-morning, a child is hypoglycemic, irritable, and stressed out. This can worsen ADHD symptoms or make some non-ADHD children act like they have the condition. Having a simple-carb, low-protein lunch will cause the same symptoms in the afternoon.
Instead, try serving breakfasts and lunches high in protein, complex carbs, and fiber — like oatmeal and a glass of milk, or peanut butter on a piece of whole grain bread. The sugars from these carbohydrates are digested more slowly, because protein, fiber, and fat eaten together result in a more gradual and sustained blood sugar release. The result? A child can concentrate and behave better at school.
Go for the Fish Oil
Omega-3’s can improve several aspects of ADHD behavior: hyperactivity, impulsivity and concentration. As a result, I recommend that all children with ADHD take omega-3 fatty acids.
Omega-3s are essential fats important for normal brain function. They are called “essential” fats because the body must get them from diet; our bodies cannot make them. Research suggests that children with ADHD have lower blood levels of omega-3’s than kids without ADHD. So, unless your child is a dedicated fish eater, you’ll have to supplement, usually with fish oil, to achieve healthy levels.
A number of studies on omega-3s and ADHD have shown a positive effect. In a 2009 study, from Sweden, 25 percent of children who had daily doses of omega-3s had a significant decrease in symptoms after three months; by six months, almost 50 percent experienced better symptom management. This is an impressive result for a safe nutritional supplement with few side effects.
How much omega-3 should your child get and in what form? It’s a little complicated. The two main omega-3 fatty acids contained in supplements are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It appears that most benefits are derived from omega-3 products that contain more EPA than DHA. I recommend a total dose of 700 to 1,000 mg a day for younger children, and 1,500 to 2,000 mg for older children.
Omega-3s come in capsule, liquid, and chewable form. The gummies and chewables, unfortunately, don’t have much fish oil in them, so it is expensive and time-consuming to give your child the proper dose. Most kids who are too young to swallow capsules can take the liquid, although you’ll have to be creative about getting them to take it. It is OK to mix liquid omega-3s in just about anything. Orange juice and smoothies are a couple of favorites.
I’ve seen some children improve within a few days, while others didn’t show improvement for a few months. My advice to parents is always to be patient, and not to give up on an omega-3 regimen too soon.
Maintain Iron Levels
Many parents and professionals are unaware of the important role iron plays in controlling ADHD symptoms.
A study done in 2004 showed that the average iron level of children with ADHD (measured as ferritin) was 22, compared with 44 in non-ADHD children. Another study showed that increasing ADHD children’s iron levels improved their symptoms almost as much as taking a stimulant. The children in these studies were not anemic. The fact that your child has a normal “blood count” does not mean that his ferritin levels are normal. Because too much iron is dangerous, I do not recommend giving iron without first checking the ferritin level. Ask your pediatrician to test it.
If iron levels are low, below 35, say, talk with your doctor about starting your child on an iron supplement and/or increasing consumption of iron-rich foods, which include lean red meat, turkey and chicken, shellfish, and beans. The ferritin level should be rechecked in a few months.
Check Zinc and Magnesium Levels
Zinc and magnesium are two other minerals that may play an important role in controlling ADHD symptoms. Both are essential to normal health, and a surprising number of children, with and without ADHD, don’t get enough of them. Zinc regulates the neurotransmitter dopamine, and it may make methylphenidate more effective by improving the brain’s response to dopamine.
Magnesium is also used to make neurotransmitters involved in attention and concentration, and it has a calming effect on the brain. Have your doctor check your child’s magnesium and zinc levels when you test ferritin levels. I find that at least 25 percent of the children I see are low in zinc.
While studies have been done on both minerals’ effects on ADHD, the results are not as clear-cut as in studies done on omega-3’s and iron.
Cut Back on Chemicals
Several studies suggest that artificial additives make non-ADHD children more hyperactive, and make hyperactive children worse. The European Union requires a warning label on food packaging that contains additives: “This food may have an adverse effect on activity and attention in children.” Gatorade, cheese puffs, and candy are typical examples of foods containing artificial colors and preservatives, but additives and colors can be found in other foods.
The first step in avoiding additives is to read food ingredient labels until you’ve found a wide range of foods that are additive-free. In most cases, fresh, unprocessed foods are your best bet, as they contain few additives.
However, these days you can find bread, cereal, cookies, pizza, and just about anything else made without additives. Avoid colorful cereals, like Fruit Loops and Lucky Charms. Cheerios are better, and lower in sugar. Substitute 100-percent fruit juice for soft drinks and fruit punches, most of which are artificially colored and flavored.
Watch for Food Sensitivities
A number of research studies have shown that many children with ADHD are sensitive to certain common foods in the diet. These sensitivities make their ADHD symptoms significantly worse. In one recent study 50 children were placed on a restricted diet for five weeks, and 78 percent of them had significant improvements in ADHD symptoms!
In my practice, I have seen improvements in many children when they stopped eating foods they were sensitive to. The most common culprits are dairy, wheat, and soy.
It’s important to know that ADHD children do not necessarily have “food allergies” in the strict, medical sense. Results when testing for food allergies are usually negative in these kids. The only way to know whether food sensitivities affect your child is to remove certain foods from his diet and observe his reaction. A child might have food sensitivities if he displays allergy symptoms, like hayfever, asthma, eczema, or GI problems. But I have seen children with none of these problems respond well to a change in diet.
If there are one or two foods you suspect might be exacerbating your child’s ADHD symptoms, eliminate one for two or three weeks. Observe your child’s ADHD symptoms during that time. If you are thinking about starting a restrictive diet, find a professional to guide you. I know dietary changes are tough to engineer in a child with ADHD, but many families have done it successfully and are happy with the results.
Try Helpful Herbs
Several herbs have been recommended for managing ADHD symptoms, including ginkgo, St. John’s Wort, rhodiola, and ginseng. Most have been poorly researched, with two exceptions.
In a large European study on hyperactivity and sleep problems, a combination of valerian and lemon balm helped to relax children with ADHD by reducing anxiety. I use these herbs regularly for kids who deal with these problems. Consult a naturopathic doctor to find the appropriate dose for your child.
To improve attention, a new herbal product, called Nurture & Clarity, was developed, and carefully tested, by a team of practitioners in Israel. The children taking it demonstrated significant improvement, as measured by their performance on the Test of Variables Attention, a computerized measurement of attention. I would not make definitive recommendations based on one study, but this product is worth looking into. You can read about it at adhd-clarity.com.
Finally, pycnogenol, an extract made from French maritime pine bark, has been shown to improve ADHD symptoms in a limited amount of research. I have found that the herb helps improve concentration in some children.
One last thought: Herbal products vary greatly in quality, and some contain contaminants. You should find a knowledgeable professional to help you identify reliable sources of pure, standardized herbs.