Q
My ten yr old son was diagnosed as having Attention Deficit Hyperactivity Disorder (ADHD) I am told by my pediatrician that diet plays a very small role and that medication is the only real solution. Meanwhile our naturopath suggests that dietary changes work as well as medication. Who do I believe?
A
The role of nutrition in the management of children with ADHD will always be controversial and to give you a short answer, I would suggest that at this time there is no definitive answer either way.
Over the past 25 years that I have cared for these patients I am concluding that there is no harm in trying to eat healthier even if it may not have a definite impact on controlling ADHD behavior better.
In February 2012 a state-of-the-art review article did a comprehensive review of all the published data on this important topic (Pediatrics Feb 2012)
When it comes to the most recent popularity of giving fatty acid supplementation to children with ADHD, the Oxford-Durham study stood out as a milestone study. When 117 children were given omega 3 and omega-6 in a ratio of 80% to 20%, and followed over 6 months, there was an improvement in coordination, reading scores and spelling skills.
Overall there was a reduction of symptoms of ADHD.
Subsequent studies did not show the same benefits and experts concluded that more studies are indicated involving a wider age range of patients and higher dosages of these essential fatty acids (Based on current studies a dose of 300-600 mg per day of omega-3 and 30-60 mg of omega-6 fatty acids seem appropriate)
Another recent landmark study from Australia, known as the Raine Study, followed children from birth to 14 years. The researchers simply wanted to see if there was a difference between the groups who ate healthy versus the group who followed a SAD eating pattern (Standard American Diet)
The SAD diet includes foods such as take away foods, red meats, processed meats, potato chips, high fat dairy products and soda pop. This diet contained foods high in sodium, fat, refined sugars and and low in fiber, folate and omega 3 and 6 fatty acids
The healthy diet included fish, either steamed or grilled, fresh fruits and vegetables, whole grains, legumes and low-fat dairy products.
It was found that children who consumed the SAD diet had a higher incidence of ADHD.
In the mid 1970’s Dr Feingold popularized a diet free of additives, preservatives and colorants.
Dr Feingold listed these foods to be avoided: apples, grapes, luncheon meats, sausages, hot dogs and any drinks containing red or orange synthetic dyes, or preservatives such as butylated hydroxytolune and butylated hydroxyanisole. Foods permitted in the Feingold diet were grapefruits, pears, pineapple, bananas, beef, lamb, milk and eggs.
The results of numerous studies did not confirm the theories and popularity of the Feingold diet. In fact in North America between 190 and 2010 there was a drop in the number of research studies regarding this diet. Currently, however in Europe and the UK there is a renewed interest in further research to see exactly how an elimination diet may help.
Allergic children with ADHD have been shown to respond better to an elimination diet (no artificial colorings and preservatives) than the non-allergic group
The role of sugar, aspartame and saccharine was reviewed and experts concluded that sugar does not usually affect the behavior or cognitive performance of children with ADHD, but an effect on a small subset of children could not be ruled out.
Using EEG mapping of the frontal brain areas in children with ADHD show that after ingestion of foods changing the glycemic levels, there is an increase in Beta activity.
Iron deficiencies have been associated with neurological conditions such as restless leg syndrome, febrile seizures and breath-holding spells. When ADHD children with low iron stores were given iron supplementation they exhibited less impulsivity, inattention and hyperactivity. They also needed fewer amphetamines to control their ADHD.
Zinc plays an important role in the metabolism of neurotransmitters and dopamine metabolism in the brain. Although some studies involved the measurement of zinc in the blood, hair and urine not all studies confirmed that zinc supplementation makes a significant difference. One study showed that zinc supplementation allowed a 37% lower use of stimulant therapy. ( J Child Adol Psychopharmacol 2011; 21(1):1-19)
Megavitamin therapy is not recommended. Numerous studies showed no significant improvement. In fact, some studies showed that mega- dosages of synthetic vitamins may put the child at risk for abnormal liver functioning (in 42% of children who took mega dosages of Vitamins there were markers of associated liver damage)
The bottom line is that healthy eating is not only about reducing ADHD, but that it benefits the whole body. Current medical knowledge is not sophisticated enough to explain why some children benefit from better nutrition, while others do not in terms of controlling their ADHD symptoms.
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