Nutrition, Diet and Alternative ADHD Treatments

A top ADHD expert explains the impact of nutrition, diet, vitamins and other alternative ADHD treatments.

by Carl Sherman, Ph.D.

You’ve heard that sugar causes attention deficit hyperactivity disorder (ADD ADHD) haven’t you? That food additives can do the same? And didn’t you read somewhere that vitamins may work just as well as medication for ADHD treatment?

These days, there's a tremendous amount of information — and misinformation — about links between ADHD and nutrition, especially for children with attention deficit disorder (ADD ADHD). To separate fallacy from fact, ADDitude’s Carl Sherman, Ph.D., spoke about ADHD treatment with one of the nation’s top experts on ADHD, Andrew Adesman, M.D., chief of developmental and behavioral pediatrics at Schneider Children’s Hospital in New Hyde Park, New York, and a member of the CHADD professional advisory board.

Is there a link between sugar and ADHD?

People blame sugar for all sorts of things. But there’s no reason to think that it causes ADHD or makes symptoms worse. Controlled studies — the ones that compare kids who are on and off sugar — haven’t found any link to attention or behavior in school-age children. In preschool children, there may be a weak association between sugar and ADHD-like symptoms. If parents feel that diet affects their preschooler’s behavior, it might make sense to try restricting sugar to see what happens.

Although I advise parents to consider limiting sweets for other reasons, including good nutrition and dental hygiene, I do not see this as an effective treatment for ADHD.

How about dyes and other food additives, or food allergies?

ADHD isn’t caused by an allergic reaction to food, or anything in food, including additives. The evidence to support elimination diets or tests for food sensitivities simply doesn’t exist. Although it would be nice if foods had fewer chemical additives and less artificial coloring, parents of children with ADHD should not let a general bias against “unnatural” food ingredients guide their approach to treating ADHD. Dietary interventions are difficult to impose and unlikely to bring any benefit.

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On the positive side, can vitamins help control symptoms of ADHD?

Some preliminary studies suggest that deficiencies of certain nutrients, including iron, zinc, magnesium, and vitamin B6, are associated with ADHD-like symptoms — and that, in these instances, correcting the deficiency might help curb symptoms. Even if these early findings are accurate, however, the number of children who might benefit from nutritional supplements is likely be small. In any case, children are not routinely screened for nutritional deficiencies. In the next few years, I believe that we will have a better understanding of how prevalent these deficiencies are, when we should test for these deficiencies, and whether supplements can help some children with ADHD.

Should parents have their kids screened for nutritional deficiencies?

Given how unlikely it would be for nutritional deficiency tests to turn up a problem, I don’t recommend that.

But if parents worry about nutritional deficiencies, and are interested in pursuing even unlikely causes of ADHD, I suppose they might ask the doctor for blood tests that could identify them or might suggest alternative treatments.

In either case, it is probably wise for children to take a daily multivitamin to ensure that they’re getting all the nutrients they need.

It’s been suggested that certain foods render ADHD medication less effective. Is that so?

To my knowledge, the only food that might affect the action of stimulant medication is grapefruit juice. It alters the way the body absorbs and breaks down amphetamines, like Adderall, and it probably should be avoided by kids or adults who take this drug. Otherwise, I don’t know of any foods that interfere with the effectiveness of ADHD medication.

This article comes from the February/March 2007 issue of ADDitude.

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Does Nutrition Make a Difference?, Part 2

On the other hand, the timing of meals might affect the efficacy of certain medications. Some newer long-acting stimulants, like Adderall XR, Focalin XR, and Ritalin LA, are absorbed more quickly on an empty stomach. If these medications are taken with food—particularly with a high-fat breakfast — they’ll be absorbed more slowly into the bloodstream and may take longer to start working. This is not a problem with Concerta or Daytrana, two long-acting methylphenidate preparations.

More research is needed to determine how big a difference meal-timing makes, and whether there’s any benefit in having a child stick to low-fat breakfasts. If a child’s ADHD medication is currently given with breakfast and does not seem to work quickly enough, perhaps it should be given an hour beforehand. The most important thing is that kids eat a hearty meal in the morning. All children, and not just those with ADHD, learn better when they’ve eaten a good breakfast.

How can parents get their children to eat well while they’re on ADHD medication?

Parents often worry that their children aren’t getting enough to eat, and that their growth will be stunted. The truth is that stimulants generally cause only modest reductions in weight and height, and there are no data to suggest that these are long-term effects.

If parents are really concerned about a child’s appetite or stature, I suppose they might ask the pediatrician about putting the child on an alternative medication. Among the stimulants, methylphenidate generally has less of an effect on weight, and possibly height, than amphetamines.

I’ve heard that low blood sugar can cause inattention. Any truth to this?

Low blood sugar can affect cognitive performance — among kids with diabetes. There’s nothing written specifically about hypoglycemia and ADHD.

There’s a lot of talk these days about fish oil. Does it affect ADHD?

Some anecdotal reports suggest an effect, but there are few hard data. One recent study found that fish-oil supplements improved attention and concentration, but another study failed to find any benefit. Taking fish oil isn’t likely to be harmful, as long as this is done in addition to, and not instead of, a proven treatment like medication.

How can parents avoid “food battles”?

As much as possible, parents should respect their children’s food preferences. If a child hates broccoli, for example, there’s no sense in trying to force him to eat it. Parents needn’t worry if a child occasionally falls short of eating a balanced, varied diet, and there’s nothing wrong with letting a child indulge a sweet tooth every once in a while.

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Flexibility is essential. Parents like to set meal times, but this may not work when medications affect a child’s appetite. It’s better to give kids as much as they want to eat when they’re hungry. Lunch is the meal most likely to be affected; many kids taking a stimulant eat very little or skip lunch altogether. If your child comes home from school hungry, give her a hearty snack rather than make her go hungry until dinnertime. If your child gets hungry later in the evening, let him have as much as he wants then.

I’m not saying that ADHD should define the family’s meal schedule. There’s something to be said for sitting down to eat together, and a big after-school snack shouldn’t preclude a child from joining the rest of the family at the dinner table.

This article comes from the February/March 2007 issue of ADDitude.

To read this issue of ADDitude in full, purchase the back issue and SUBSCRIBE NOW to ensure you don't miss a single issue.