Explaining the power of protein and other dietary strategies for easing symptoms of attention deficit disorder (ADD ADHD) with an alternative treatment.
by Tina Adler
Lisa Vohra knows one thing for sure: If her eight-year-old daughter, who has ADD, eats sweets - or, for that matter, any carbohydrates - protein has to be part of the picture.
"I've explained to Priya that she needs protein with carbs, so her blood sugar won't spike," says Vohra, a stay-at-home mom from Alexandria, Virginia. With the inevitable drop in blood sugar following a spike, "she becomes unfocused."
So instead of a breakfast bar (with 20-plus grams of sugar), Priya often starts the day with an egg. And lunch is frequently protein-rich leftovers from the previous evening's supper, with nuts or soy chips for an afternoon snack.
Vohra says that using protein to "buffer" Priya's carbohydrate intake has helped her daughter do better at school. In fact, Priya's classroom behavior improved so dramatically that her teacher asked if she had started taking medication. (She hasn't, because her neurologist worries that drug therapy will blunt her already-iffy appetite.)
Protein buffering is one of several nutritional strategies employed by parents of children with ADD. Ask five parents of kids with ADD about dietary interventions that help their children, and you'll hear five different theories. Check with health experts about what sort of diet helps kids or adults with ADD, and you'll hear even more.
Poor eating habits do not cause ADD. And when it comes to controlling impulsivity, inattention, and other symptoms, there is no substitute for medication and behavioral therapy, which are clearly the most effective approaches. But recent research suggests a possible relationship between ADD and the foods one consumes. Read on to find out how to make your diet - or your family's - ADD-friendly.
The brain makes a variety of chemical messengers, or neurotransmitters, to regulate wakefulness and sleep. Certain neurotransmitters, including dopamine and norepinephrine, boost alertness. Others, including serotonin, cause drowsiness. Studies by Massachusetts Institute of Technology neuroscientist Richard Wurtman, Ph.D., and others have shown that dietary protein triggers the synthesis of alertness-inducing neurotransmitters, while dietary carbohydrates trigger the synthesis of neurotransmitters that cause drowsiness.
These findings lend credence to the popular belief that people with ADD fare better on a protein-rich breakfast and lunch. Yet many children, including some with ADD, aren't getting enough protein, says Faye Berger Mitchell, a registered dietitian in Bethesda, Maryland, whose own daughter has ADD. Child psychologist Vincent J. Monastra, Ph.D., head of an ADD clinic in Endicott, New York, agrees. He estimates that, of the 500 children a year he evaluates for ADD, less than 5 percent are ingesting the government-recommended amounts of protein at breakfast and lunch. In addition to boosting alertness, says Monastra, a protein-rich breakfast seems to reduce the likelihood that ADD medication will cause irritability or restlessness.
If your family's idea of breakfast is toast, sugary cereals, or doughnuts, don't panic. You don't have to gobble a plate of huevos rancheros or eggs and bacon to get enough protein. "We're not talking about a ton of food," says Monastra, author of Parenting Children with ADD: 10 Lessons That Medicine Cannot Teach. Depending on their age, children need between 24 to 30 grams of protein a day. Adults need 45 to 70 grams. You can get seven grams in a cup of milk or soy milk, one egg, or an ounce of cheese or meat.
"I used to serve any cereal they wanted for breakfast," says Alice, a mother of four - three of whom have ADD - from Churchville, New York. "Now I keep buy them cereals that are lower in sugar, or Hot Pockets with scrambled eggs in them. And I have the kids drink milk."
In the 1970s, Benjamin Feingold, M.D., a pediatrician and allergist at Kaiser Permanente Medical Center in San Francisco, began championing a specialized eating plan that he said could help alleviate symptoms of ADD. The Feingold diet forbids artificial food colors, flavorings, sweeteners, and preservatives, as well as salicylates, naturally occurring compounds found in some fruits and vegetables.
Studies failed to uphold Feingold's claims when he first made them, and most ADD experts still dismiss the Feingold diet as ineffective. Yet some recent research suggests that the Feingold diet may be beneficial to the 5 percent or so of children with ADD who seem to be sensitive to chemicals in food.
One study, published in the December 2004 issue of the Journal of Developmental and Behavioral Pediatrics, analyzed 15 previously published studies and concluded that artificial food colors exacerbate hyperactivity, irritability, and insomnia in some kids with ADD.
Many parents use the Feingold diet with their kids who have ADD, saying there are obvious benefits. Marilee Jones of Oakdale, Connecticut, put her son, now 17, on the Feingold diet when he was a toddler. Prior to the diet, he was hyperactive and had dark circles under his eyes from not sleeping. "We put him on the diet, and everything changed. He became a normal 18-month-old," says Jones, who now works for the Feingold Association.
Even now, says Jones, her son notices that if he strays too far from the diet and, say, indulges in a soft drink with artificial food coloring, his personality changes.
Recent studies suggest that sensitivities to certain foods may worsen symptoms of ADD in children.
When kids with ADD are placed on a special elimination diet - excluding foods that trigger unwanted behavior - as many as 30 percent of toddlers and preschoolers benefit, says Eugene Arnold, M.D., author of A Family's Guide to Attention-Deficit/Hyperactivity Disorder, and professor emeritus of psychiatry at Ohio State University. He says that such a diet does not seem to have any effect on adults with ADD.
On an elimination diet, you start by eating only foods unlikely to cause reactions: lamb, chicken, potatoes, rice, bananas, apples, cucumbers, celery, carrots, parsnips, cabbage, cauliflower, broccoli, salt, pepper, and vitamin supplements. Then you restore other foods, one at a time, to see whether they cause a reaction.
If nothing happens in two weeks - if you see no difference in your child's behavior - stop the experiment. If you notice an improvement, reintroduce one excluded food each day and watch what happens. If the child has a bad response to the food - if he becomes more fidgety or has trouble sleeping, for example - eliminate it again. If it's a food your child is particularly fond of, try reintroducing it again a year or so later. If they're not repeatedly exposed to the trigger food, children often outgrow sensitivities.
If you'd like to try the diet with your children at home, Dr. Arnold recommends consulting a registered dietician (go to eatright.org).
When it comes to the role of sugar in children's behavior, there seem to be nearly as many opinions as brands of sugar-coated cereal.
Most parents of children with ADD - 84 percent of 302 parents in one 2003 study - believe that sugar has a negative effect on their kids' behavior. And many adults with ADD are convinced that sugar worsens their symptoms as well.
"I switched from a diet that was high in sugar to one that's much lower," says Darcy LaClair, a graduate student at the University of Notre Dame. "I'm more focused when I'm careful about what I eat. This is especially important to me, since I've had a problem finding a suitable medication."
But medical experts still tend to discount any link between behavior and sugar or artificial sweeteners. As evidence, they point to a pair of studies that appeared in the New England Journal of Medicine. "Effects of Diets High in Sucrose or Aspartame on the Behavior and Cognitive Performance of Children" (February 3, 1994) found that "even when intake exceeds typical dietary levels, neither dietary sucrose nor aspartame affects children's behavior or cognitive function." A similar study, "The Effect of Sugar on Behavior or Cognition in Children" (November 22, 1995), reached much the same conclusion - though the possibility that sugar may have a mild effect on certain children "cannot be ruled out," according to the study's authors.
In any case, sugar carries loads of calories and has no real nutritional value. People who eat lots of sweets may be missing out on essential nutrients that might keep them calm and focused. Since ADD medications tend to blunt the appetite, it's important to make every calorie count.