Nutrition & Attention Deficit/

June 2001

A recent review of attention deficit/hyperactivity disorder (ADD/ADHD) noted prevalence rates generally ranging from 4% to 12% in the general population of six to12-year-olds, with higher rates of the disorder among males and with higher rates reported from school settings than from community settings (Pediatrics, March 2001, “Prevalence and assessment of attention-deficit/ hyperactivity disorder in primary care settings”). The diagnosis may be only inattentiveness (ADD) or a hyperactivity problem (ADHD).

According to “The A.D.D. Book: New Understandings, New Approaches to Parenting Your Child,” by Sears and Thompson, “ADD is a collection of traits that reflect the child’s inborn, neurologically based temperament.” Positive ADD traits include spontaneity, creativity and the ability to focus on tasks of the child’s own choosing; traits that may present potential problems include selective attention, distractibility, impulsivity and, sometimes, hyperactivity.

Medication can control many symptoms, but doesn’t address the underlying causes and may result in side effects. Therefore, many parents and health practitioners are looking for diet-based alternatives.

The Feingold Diet, popular in the 1970s, promotes the elimination of artificial flavorings, colorings and salicylates in foods. According to Children and Adults with Attention-Deficit/ Hyperactivity Disorder (CHADD), Landover, MD, dozens of well-controlled studies published in peer-reviewed journals in the past 15 years have consistently failed to support the diet as a standard treatment. However, some children respond positively to certain aspects of this diet.

Nutrient-dense foods
Malnutrition can alter brain function, so the first step is to ensure a nutritionally sound diet from an early age. For instance, studies find enhanced cognition and learning when children consistently eat breakfast, especially in nutritionally at-risk children, according to the American Journal of Clinical Nutrition, April 1998, “Breakfast and Cognition: An integrative summary.”

Skipping meals and taking in consistent carbohydrate levels to keep blood sugars steady are other concerns. Sears and Thompson recommend providing the brain with a steady supply of carbohydrates and encourage the consumption of low-glycemic-index carbohydrates, such as oats, legumes, milk and milk products, pasta and fruits.

Exploring food sensitivities
“I think there’s clear evidence about food and food-additive sensitivities,” says Laura J. Stevens, M.S., research associate, Purdue University Foods & Nutrition Department, West Lafayette, IN, and author of “12 Effective Ways to Help Your ADD/ADHD Child.” Stevens has worked with nutrition and ADD/ADHD since 1990.

Food allergies or sensitivities are possible culprits in certain cases. Different children respond to a range of foods. Stevens says common food problems may be artificial colors and flavors. Milk, chocolate and sugar may negatively affect some kids, and wheat, corn, rye, egg, citrus and legumes are potential concerns.

In one study of a diet eliminating artificial colors, preservatives, milk, eggs, chocolate, sugar, wheat, soy and oranges, 82% of overactive children improved behaviorally (The Lancet March 9, 1995, “Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome”).

Specific mineral deficiencies
A sufficient amount of iron is important for proper brain neurotransmitter activity. Children with iron deficiency and anemia may exhibit slightly impaired scores on developmental assessment. Insufficient iron in a child’s diet potentially can contribute to ADD/ ADHD symptoms, such as inattentiveness, aggression and irritability.

Comparison of dietary intakes of zinc with requirements suggests that children may be at risk for zinc deficiency, with signs including loss of appetite, slow growth and delayed wound healing. Zinc plays an important role in immune-system development and is a vital cofactor in key metabolic pathways. According to Steven’s book, in one study, blood serum zinc levels of children with ADHD were found to be significantly lower than levels in children without ADHD.

Although more studies need to be conducted, magnesium deficiency also may be common in this disorder. Some children with ADD/ADHD reportedly have low magnesium levels, and supplementation with additional magnesium has led to a significant decrease in hyperactivity in some.

Essential fatty acids
Brain cells and the myelin sheath around each nerve depend on an adequate nutritional supply of healthful fats and essential-fatty-acids (EFAs). Some physical symptoms reported in ADHD are similar to those observed in EFA deficiency in animals and humans.

A subgroup of ADHD subjects reporting many symptoms of EFA deficiency had significantly lower proportions of plasma arachidonic and docosahexaenoic acid than did ADHD subjects with few symptoms or control subjects. In addition, subjects with lower compositions of total omega-3 fatty acids had significantly more behavioral problems, temper tantrums and learning, health and sleep problems than did those with high proportions of omega-3 fatty acids (American Journal of Clinical Nutrition, January 2000, “Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder”).

“We think there is a relationship of some kind between fatty acids and ADHD in kids showing some kinds of fatty-acid deficiency,” says Stevens, who feels that omega-3 fatty acids are low in the American diet. “I think it’s safe to add flaxseed oil to the diet — anywhere from 1 to 3 teaspoons daily.” Stevens recommends monitoring behavior and symptoms while adding gradual EFA amounts to the diet.

It’s evident from the studies that children with ADD/ADHD may benefit from being assessed individually for potential food and chemical sensitivities, nutritional deficiencies, and the need for food or nutrient supplementation. It appears that no single diet is appropriate for every child, but for some, nutrition therapy may make a difference.

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