Fish Oil & Beyond: Our Readers’ Most Popular Supplements for ADHD
More than half of caregivers and adults surveyed by ADDitude said they’ve either tried, or they currently use vitamins, minerals, and other supplements to treat symptoms of ADHD — sometimes without good evidence that they work. Here’s what the science reveals about the effectiveness of the most popular supplements for ADHD such as magnesium, zinc, and vitamin B6.
The ADHD medications available today are, generally speaking, very effective at managing symptoms like impulsivity, hyperactivity, and inattention.1 But ADHD is a complex condition that may respond best to a multi-modal treatment plan. Which is why many clinicians recommend an integrative approach supplementing medications with behavioral therapy, nutrition, exercise, and/or vitamins and minerals.
According to a 2017 ADDitude survey of 2,495 parents and 1,563 adults with ADHD, more than half of respondents said they had tried vitamins, minerals, or other supplements to treat their children or themselves. The most popular supplements noted in the survey were fish oil, magnesium, vitamins B6 and C, zinc, and iron.
The big question is: How well do supplements work? Only about 12 percent of people surveyed by ADDitude found them to be “very effective.” More than 40 percent of parents and more than a third of adults said they were either “not very effective” or “not at all effective.” Still, many respondents continued to take supplements or give them to their children.
While research shows some supplements help with ADHD symptoms, others have little evidence to support them as a solitary treatment. “In my practice, the combination of nutritional support with medications is probably the most common and most effective use,” says James Greenblatt, MD, chief medical officer at Walden Behavioral Care in Waltham, Massachusetts, and author of Finally Focused: the Breakthrough Natural Treatment Plan for ADHD.
Many of the parents and adults surveyed said they followed an integrative approach, combining stimulants or other medications with supplements. “We use them in conjunction with the Adderall and are seeing very positive results with the combination,” one parent noted in the 2017 ADDitude survey.
[Download This Free Guide to ADHD Vitamins & Minerals]
Fish Oil for ADHD
By far the most popular supplement among survey respondents was fish oil, which nearly 80 percent of parents and more than 76 percent of adults had used to manage ADHD. Fish oil contains the polyunsaturated fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are thought to influence the production and release of neurotransmitters — chemicals like serotonin and dopamine that help brain cells communicate. These fatty acids also reduce inflammation in the body. Research suggests that children with ADHD have lower omega-3 levels than do other kids their age.3
Reviews of studies on the impact of fatty acids on ADHD have found a moderate improvement in symptoms — especially from formulations containing a higher ratio of EPA to DHA.4,5,6 Although these supplements don’t work as well as stimulant drugs, given their mild side effects they can be a useful add-on to medication, researchers say.7
User reviews on omega-3s were mixed. One survey respondent said fish oil helps their son “with focus” and “makes him less distracted, better in school.” An adult wrote, “When I don’t take it, I feel really off.” But another parent “did not notice an effect at all and discontinued.”
The recommended fatty acid dose in children is 1 to 2 g/day.8 Supplements come in capsules, as well as liquids and gummies for kids who are too young to swallow pills. Some kids balk at the fishy aftertaste, or the fish burps these supplements can produce, which one parent complained led to a “daily morning battle of the wills.” One easy solution is to put the capsules in the freezer, says Sanford Newmark, MD, director of Clinical Programs and integrative pediatrician at the UCSF Osher Center for Integrative Medicine. Freezing slows the rate at which the stomach breaks down the fish oil, which cuts down on the fishy aftertaste.
[Your Free Guide to Flavorful Fish Oil]
Magnesium, Zinc, and Iron for ADHD
All three of these minerals are important for regulating levels of neurotransmitters and other brain chemicals, such as melatonin. Children with ADHD are more likely to be lacking in magnesium, zinc, and iron than are their peers. This deficiency, researchers say, might contribute to ADHD symptoms.9,10 Yet it’s unclear whether taking these supplements improves symptoms — especially in people who aren’t deficient. And few doctors routinely test for deficiencies in their patients with ADHD.11
Magnesium was the most popular of the three minerals among ADDitude survey respondents. Nearly 29 percent of parents and almost 42 percent of adults had used it. “Magnesium is not really good for attention and focus, but it is good for calming kids down,” Newmark says. He recommends it to help with sleep, and to combat late afternoon hyperactivity when ADHD medications start to wear off. One adult found that magnesium “helps to tone down heart racing, hyperactivity, and stress/anxiety.” The main side effects from magnesium are diarrhea and belly pain. Doses of less than 200 mg/day are recommended to avoid these and other adverse effects in children.12
Nearly 18 percent of parents and more than 26 percent of adults surveyed said they’ve used zinc for ADHD symptoms. A deficiency of this mineral is more common in developing nations than it is in the United States, but people who are lacking may be more inattentive and jittery.13 One Turkish study of more than 200 children with ADHD found improvements in attention and hyperactivity among kids who took zinc.14 Adding zinc to stimulant drugs might enhance the treatment effect.15 Because researchers have used inconsistent amounts of zinc in studies, no real recommendations on the optimal dose exist.16
Iron deficiency is associated with attention issues, Greenblatt says. However, he adds that no one should take iron without first having their ferritin levels tested to make sure they are deficient. As of now, there’s no evidence to show that taking iron supplements helps anyone with normal stores of this mineral.17
Some people find that minerals and vitamins work best when combined, although it then becomes difficult to tease out which ones are actually working. One parent whose son takes a mix of zinc, iron, magnesium, and vitamins B6 and C said these supplements transformed their home from “chaos” to “one of calm and routine where everything runs smoothly.” “He was cooperative and more organized. It was like we had a different child,” she wrote.
Vitamins B6, C, and D
Nearly 23 percent of children and almost 42 percent of adults have tried vitamin B6 for ADHD, according to the survey. This vitamin is involved in the metabolism of polyunsaturated fatty acids, and the transmission of nerve impulses in the brain.18 One adult noted that taking B vitamins daily “helps me feel connected to my brain.” Some supplements pair magnesium with vitamin B6, and research suggests that the combination might help with hyperactivity, aggressiveness, and school attention.19
Vitamin C was another popular supplement, with more than 21 percent of children and 30 percent of adults having tried it. Research on this vitamin for ADHD is limited, but one study found that a combination of vitamin C and fatty acids (in the form of flax oil) reduced hyperactivity scores.20
Vitamin D is another common deficiency among children with ADHD.21 Greenblatt says it’s often missed in kids, but “not everyone should go out and take a lot of vitamin D.” Researchers are still trying to determine whether supplementation improves ADHD symptoms. Early evidence suggests it might.22
Melatonin for ADHD
Sleep issues are common in patients with ADHD. Up to 80 percent of kids with the condition have difficulty falling asleep or staying asleep throughout the night.23 Melatonin is a hormone naturally produced by the pineal gland in the brain that helps regulate sleep-wake cycles.
Research shows that melatonin helps people with ADHD fall asleep faster and sleep longer each night.24 Andrea, a mother in Louisville, Kentucky, refers to melatonin as a “godsend” for ending the two- to four-hour bedtime battles she once fought with her six-year-old son. He would resist sleep each night, “throwing himself off our bed and banging into a wall.” After giving him a melatonin gummy, “He curled in our laps so we could read him a book,” she says. “That had never happened before.”
“Melatonin is a very safe supplement, and it’s very clear that it works,” Bloch says. The ideal dose for children is 3 to 6 mg (depending on the child’s weight), given 30 to 60 minutes before bedtime.25,26 Kids who take stimulants may need a higher dose — 5 to 10 mg.27
Tips for Trying Supplements
Finding the right supplement can take some trial and error. Chantelle Pratt, a mother in Queensland, Australia, has tried various mixtures of vitamins B6 and C, as well as iron, magnesium, and combination formulas like Becozinc and Energy X on her 8-year-old son. “All have been effective, depending on what is needed at the time,” she says. “Levels typically needed adjusting every time a growth spurt occurred or any other cognitive changes occurred.”
If you’re interested in trying supplements on your child or yourself, it’s best to check with your pediatrician or primary care doctor first to make sure that it’s appropriate and you have the right dose. The majority of people surveyed — more than 60 percent — said they had researched and tried products on their own, without a doctor’s recommendation.
“You don’t want to take supplements long-term without somebody providing guidance,” Greenblatt says. He suggests finding a doctor who is trained in integrative and functional medicine, because not all pediatricians and primary care providers are well versed in the use of supplements.
Whenever you use supplements for yourself or your child, do so thoughtfully. Some people surveyed didn’t see any measurable improvement but still stuck with the pills, figuring, “they can’t hurt.” One adult respondent said they “haven’t noticed a difference taking fish oil, magnesium, B6 for the last three years, but continue to take them because I keep reading that it’s beneficial.”
Given the cost and effort involved in taking these products, you could waste money and energy by staying on an ineffective supplement. Overdoing it with too many supplements could also lower your odds of sticking with the regimen. “The more pills you take, the less likely you are to take them,” Bloch says. After all, even the best omega 3 supplement is useless if you forget to take it.
If supplements don’t seem to be working after a few months, consider stopping them. “That’s where focusing on nutrients and diet would be better,” Greenblatt says.
Also use caution when choosing a supplement brand. The FDA doesn’t regulate nutritional products like it does drugs. Look to an independent organization like ConsumerLab.com, which checks to make sure that any ingredients the manufacturer claims are in the bottle are actually there.
Finally, watch for side effects. “People can have all sorts of reactions to supplements. Iron can cause stomachaches or constipation. Zinc can cause stomach upset,” Newmark says. “Whenever you start a supplement, you should pay attention.”
[Buy This eBook: The ADDitude Guide to Treating ADHD Naturally]
Footnotes
1American Academy of Pediatrics. “Common ADHD Medications & Treatments for Children.”
2Tanzi, Maria G. Omega-3 fatty acids for pediatric ADHD. Pharmacy Today. February 2012.
3Parletta, N. Omega-3 and omega-6 polyunsaturated fatty acid levels and correlations with symptoms in children with attention deficit hyperactivity disorder, autistic spectrum disorder and typically developing controls. PLOS One. May 27, 2016.
4 Matsudaira, T., et al. Biochemical and psychological effects of omega-3/6 supplements in male adolescents with attention-deficit/hyperactivity disorder: A randomized, placebo-controlled, clinical trial. Journal of Child and Adolescent Psychopharmacology. 2015 Dec.
5Bloch, M.H., et al. Nutritional supplements for the treatment of attention-deficit. August 12, 2014.
6Chang, J.P., et al. Omega-3 polyunsaturated fatty acids in youths with attention deficit hyperactivity disorder (ADHD): A systematic review and meta-analysis of clinical trials and biological studies. Neuropsychopharmacology. 2018.
7Bloch, M.H., et al. Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomology: Systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychology. October 2011.
8Bloch, M.H., et al. Nutritional supplements for the treatment of attention-deficit. August 12, 2014.
9Hariri, M., et al. Magnesium, iron and zinc supplementation for the treatment of attention deficit hyperactivity disorder: A systematic review on the recent literature. International Journal of Preventive Medicine. 2015.
10Bloch, M.H., et al. Nutritional supplements for the treatment of attention-deficit. August 12, 2014.
12Bloch, M.H., et al. Nutritional supplements for the treatment of attention-deficit. August 12, 2014.
13Bloch, M.H., et al. Nutritional supplements for the treatment of attention-deficit. August 12, 2014.
14Villagomez, A., et al. Iron, magnesium, vitamin D, and zinc deficiencies in children presenting with symptoms of attention-deficit/hyperactivity disorder. Children. December 2014.
15Esparham, A., et al. Pediatric integrative medicine approach to attention deficit hyperactivity disorder (ADHD). Children. September 2014.
16Bloch, M.H., et al. Nutritional supplements for the treatment of attention-deficit. August 12, 2014.
17Bloch, M.H., et al. Nutritional supplements for the treatment of attention-deficit. August 12, 2014.
18Esparham, A., et al. Pediatric integrative medicine approach to attention deficit hyperactivity disorder (ADHD). Children. September 2014.
19El Baza, F., et al. Magnesium supplementation in children with attention deficit hyperactivity disorder. Egyptian Journal of Medical Human Genetics. January 2016.
20Ahn, J., et al. Natural product-derived treatments for attention-deficit/hyperactivity disorder: Safety, efficacy, and therapeutic potential of combination therapy. Neural Plasticity. 2016.
21Sharif, Mohammad Reza, et al. The relationship between serum vitamin D level and attention deficit hyperactivity disorder. Iranian Journal of Child Neurology. Autumn 2015.
22Elshorbagy, H.H., et al. Impact of vitamin D supplementation on attention-deficit hyperactivity disorder in children. The Annals of Pharmacotherapy. July 2018.
23Cuesta, Soraya Otero, et al. Use of melatonin in children and adolescents with primary sleep disorders and sleep disorders associated to autism spectrum disorder and attention deficit-hyperactivity. Journal of Pediatric Care. January 2016.
24Bloch, M.H., et al. Nutritional supplements for the treatment of attention-deficit. August 12, 2014.
25Cuesta, Soraya Otero, et al. Use of melatonin in children and adolescents with primary sleep disorders and sleep disorders associated to autism spectrum disorder and attention deficit-hyperactivity. Journal of Pediatric Care. January 2016.
26Bloch, M.H., et al. Nutritional supplements for the treatment of attention-deficit. August 12, 2014.
27Cuesta, Soraya Otero, et al. Use of melatonin in children and adolescents with primary sleep disorders and sleep disorders associated to autism spectrum disorder and attention deficit-hyperactivity. Journal of Pediatric Care. January 2016.
