Change Your Diet, Find Your Focus
Studies show that protein promotes alertness in the brain. Carbohydrates do the opposite. And artificial colors and flavors are even worse. Which may explain why Fruity Pebbles are so awful for your child with ADHD. Read on for more trigger foods, and for healthier alternatives.
Research shows that what you feed your body has a direct correlation to how your brain functions. Diet and nutrition impact cognition, attention, sleep, and mood. According to the Harvard Health Blog1, studies show that people who eat “clean” or “whole” diets high in vegetables, fruits, unprocessed grains, and lean meats, are more likely to experience better emotional health and 25 to 35 percent less likely to experience mood disorders.
Can a clean, natural diet help combat symptoms of ADHD? Adults and parents of children with ADHD are finding that, while whole foods may not be a cure-all, diet changes can make a big difference for some patients. Nutrition and ADHD go hand-in-hand.
Poor diet and eating habits do not cause ADHD. 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 — and the only ones recommended by the American Academy of Pediatrics.
Still, adults and parents of children with attention deficit have long reported a connection between the kinds of foods they eat and their behavior and symptoms. Now, science is beginning to add credence to those observations.
Research shows that protein promotes alertness in the brain. Carbohydrates do the opposite. And artificial colors and flavors are even worse. Which may explain why Fruity Pebbles are one of the worst breakfasts for your child.
In essence, the better you want your brain to perform, the more unprocessed foods, proteins, vegetables, and fruits you should eat.
Two studies show a relationship between diet and ADHD symptoms. One, published in Pediatrics2 in 2010, concluded that pesticides, specifically organophosphates, found on fruits and vegetables may be linked to ADHD. The higher the levels of the compounds detected in a child’s urine, the more likely he or she is to be diagnosed with ADHD. (The answer? Eat organic, suggest the study’s authors.) Another study, published in the Journal of Attention Disorders3 in 2010, showed that a Western diet — processed meats, fast foods, high-fat dairy products, and sugary foods — doubled the risk of having an ADHD diagnosis, compared with a healthier diet.
Nutrition affects the ADHD brain in three ways.
1. Brain cells, like other cells in the body, need proper nutrition to carry out their functions.
2. The myelin sheath, which covers the axons of brain cells, as insulation covers electrical wires, needs the right levels of nutrients to speed transmission of the electrical signals between brain cells.
3. Neurotransmitters — dopamine, serotonin, and norepinephrine — are also dependent on diet for proper functioning.
If the right nutrients aren’t accessible to the brain, its circuits misfire. Read on to find out what nutrients an ADHD brain needs to function well.
What to Eat
Carbs and ADHD Brain Power
Carbs affect brain function and mood. The rate at which sugar from a particular food enters brain cells, and other cells of the body, is called the “glycemic index” (GI). Foods with a high glycemic index stimulate the pancreas to secrete high levels of insulin, which causes sugar to empty quickly from the blood into the cells. Insulin regulates the ups and downs of blood sugar, and the rollercoaster behavior that sometimes goes with them. Low-glycemic foods deliver a steady supply of sugar, helping a person with ADHD control behavior and improve performance
Foods with the best brain sugars include:
Fruits: grapefruit, apples, cherries, oranges, and grapes. Fruits have a lower GI than do fruit juices, because fiber in fruit slows the absorption of fruit sugar. A whole apple is more brain-friendly than apple juice; a whole orange better than orange juice. Please note that the acid in oranges, grapefruits, and their juices interrupts the absorption of short-acting stimulant ADHD medications and should be avoided when taking these prescriptions.
Cereals and grains: oatmeal, bran, higher-fiber cereals and pastas also have a low GI. Corn flakes and sugarcoated breakfast cereals have higher GIs, and should be avoided.
Vegetables and legumes: legumes, such as soybeans, kidney beans, and lentils have the lowest GI of any food.
Dairy products: Milk and yogurt have low GIs, slightly higher than legumes, but lower than fruits. Plain yogurt has a lower GI than yogurt with fruit preserves or sugar added.
Protein and ADHD Brain Power
The brain makes a variety of chemical messengers, or neurotransmitters, to regulate wakefulness and sleep. Studies4 by Massachusetts Institute of Technology neuroscientist Richard Wurtman Ph.D., and others have shown that protein triggers alertness-inducing neurotransmitters, while carbohydrates trigger drowsiness.
These findings support the popular belief that people with ADHD do better after eating a protein-rich breakfast and lunch. Yet child psychologist Vincent J. Monastra, Ph.D., head of an ADHD clinic in New York says that, of the 500 children a year he evaluates for ADHD, less than 5 percent are eating 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 ADHD medication will cause irritability or restlessness.
Proteins affect brain performance by providing the amino acids from which neurotransmitters are made. Neurotransmitters are biochemical messengers that carry signals from one brain cell to another. The better you feed these messengers, the more efficiently and accurately they deliver the goods, allowing your child to be alert at school or you to be more on top of things at work.
Two amino acids, tryptophan and tyrosine, are important building blocks of neurotransmitters. These amino acids influence the four top neurotransmitters — serotonin, which is made from the amino acid tryptophan, as well as dopamine, epinephrine, and norepinephrine, which are made from the amino acid tyrosine. Tryptophan is an essential amino acid. The body does not make it; it must be supplied by the diet. The body can make tyrosine if there is not enough in the diet.
“Because the body makes brain-awakening neurotransmitters when you eat protein, start your day with a breakfast that includes protein,” says Laura Stevens, M.S., a nutritionist at Purdue University and author of 12 Effective Ways to Help Your ADD/ADHD Child. “Also look for ways to slip in lean protein during the day, as well.”
“Protein helps keep blood sugar levels steady, and prevents the mental declines that come from eating a meal containing too many simple carbs,” says Ned Hallowell, M.D., author of Driven to Distraction.
If your family’s idea of breakfast is toast, sugary cereals, or doughnuts, don’t panic. You don’t need to eat a plate of eggs and bacon every morning to meet your daily protein requirements. “We’re not talking about a ton of food,” says Monastra, author of Parenting Children with ADHD: 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 7 grams in a cup of milk or soy milk, one egg, or an ounce of cheese or meat.
5 Balanced Breakfasts
A nutrition-packed breakfast should contain a balance of complex carbohydrates and protein.
Think grains, plus dairy, plus fruits. For example:
1. Granola cereal, yogurt, sliced apple
2. Scrambled eggs, whole-grain toast, orange
3. Veggie omelet, bran muffin, fresh fruit with yogurt
4. Whole-grain pancakes or waffles topped with berries and/or yogurt, milk
5. Low-fat cheese melted on wholegrain toast, pear
Fat, Fish Oil, and ADHD Brain Power
“Fats make up 60 percent of the brain and the nerves that run every system in the body,” says William Sears, M.D., an associate clinical professor of pediatrics at the University of California, Irvine, School of Medicine. “The better the fat in the diet, the better the brain will function.”
Most important to brain function are the two essential fatty acids found in fish oil: linoleic (or omega 6) and alpha linolenic (or omega 3). These are the prime structural components of brain cell membranes, and an important part of the enzymes that allow cell membranes to transport nutrients in and out of cells. Western diets contain too many omega-6 fatty acids and too few of the omega 3s, which are found in cold-water fish (primarily salmon and tuna), soybeans, walnuts, wheat germ, pumpkin seeds, and eggs. Flaxseed and canola oils are good sources of omega 3s.
“Individuals with ADHD who have low levels of omega 3s will show the biggest improvement in mental focus and cognitive function when they add more of these healthy fats to their diet,” says Richard Brown, M.D., associate clinical professor of psychiatry at Columbia University College of Physicians and Surgeons.
Vitamins and ADHD Brain Power
Studies5 indicate that children in grade school whose diets are supplemented with appropriate vitamins and minerals scored higher on intelligence tests than did those who took no supplements. This is encouraging news, but it comes with an important caveat: Genetic abnormalities such as MTHFR can make some supplements difficult, even dangerous. For this reason and others, you should always consult with your physician before introducing a new vitamin or supplement to your or your child’s diet. Even the seemingly innocuous vitamin B can cause serious side effects in certain individuals.
Here are some specific vitamins and minerals that affect behavior and learning in children and adults:
Vitamin C is required by the brain to make neurotransmitters. In fact, the brain has a special vitamin c “pump,” which draws extra vitamin c out of the blood into the brain.
Vitamin B6 deficiency causes irritability and fatigue. Adequate levels of the vitamin increase the brain’s levels of the neurotransmitter dopamine, increasing alertness.
Iron is also necessary for making dopamine. One small study6 showed ferritin levels (a measure of iron stores) to be low in 84 percent of children with ADHD, compared to 18 percent of a control group. Low iron levels correlate with severe ADHD.
Zinc regulates the neurotransmitter dopamine, and may make methylphenidate more effective by improving the brain’s response to dopamine7. Low levels of this mineral correlate with inattention.
More of these nutrients is not necessarily better, and sometimes problematic. Studies8 using megavitamin therapy in children with ADHD showed no effect.
What Not to Eat
Food Sensitivities and Elimination Diets
Studies9 show that sensitivities to certain foods may worsen symptoms of ADHD in children.
When 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 ADHD.
On an elimination diet, you start by eating only foods unlikely to cause reactions:
- 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 really likes, try reintroducing it again a year or so later. When not repeatedly exposed to a 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).
The Feingold Diet
In the 1970s, Benjamin Feingold M.D., a pediatrician and allergist at Kaiser Permanente Medical Center in San Francisco, introduced an eating plan that he said could help alleviate symptoms of ADHD. 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 ADHD experts still dismiss the Feingold diet as ineffective. Yet some recent research suggests that the Feingold diet may be beneficial to the small percent of children with ADHD who seem sensitive to chemicals in food.
One study10, 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 can lead to hyperactivity, irritability, and insomnia in some kids with ADHD.
Many parents say they use the Feingold Diet despite a lack of clear scientific evidence because, quite simply, it works for their families. 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.
The Sugar Debate
Most parents of children with ADHD — 84 percent of 302 parents in one 2003 study11 — believe that sugar has a negative effect on their kids’ behavior. And many adults with ADHD are convinced that sugar worsens their symptoms as well.
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 Medicine12 13. “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 ADHD medications tend to blunt the appetite, it’s important to make every calorie count.
The most recent review14 of all the studies on diet and ADHD, concluded and published in 2014, found mixed outcomes, which proves the science is still shaky in this area. They found that parents often reported behavior changes with artificial food colorants and additives, but teachers and clinical tests didn’t report the same level of change. They could conclude that artificial colors do react adversely with ADHD symptoms in some children. The studies on sugar and artificial colors had negligible results as well, thwarting the theory that sugar and artificial sweeteners cause ADHD symptoms. And all studies on the effect of elimination diets on ADHD symptoms that they looked at found statistically significant ADHD symptom reduction when the children were given a narrow diet of foods unlikely to cause reactions.
What you or your child with ADHD eats is very important, and can have an impact on ADHD symptoms.
1 MD, Eva Selhub. “Nutritional Psychiatry: Your Brain on Food.” Harvard Health Blog. Harvard Health Publications, 17 Nov. 2015.
2 Bouchard, M. F., D. C. Bellinger, R. O. Wright, and M. G. Weisskopf. “Attention-Deficit/Hyperactivity Disorder and Urinary Metabolites of Organophosphate Pesticides.” Pediatrics, vol. 125, no. 6, 2010.
3 Amber L. Howard, Monique Robinson, Grant J. Smith, Gina L. Ambrosini, Jan P. Piek, and Wendy H. Oddy. “ADHD Is Associated With a ‘Western’ Dietary Pattern in Adolescents.” Journal of Attention Disorders, 2010; DOI: 10.1177/1087054710365990
4 Wurtman, Richard J. “Nutrients That Modify Brain Function.” Scientific American, vol. 246, no. 4, 1982, pp. 50–59., doi:10.1038/scientificamerican0482-50.
5 Schoenthaler, Stephen J., et al. “The Effect of Vitamin-Mineral Supplementation on the Intelligence of American Schoolchildren: A Randomized, Double-Blind Placebo-Controlled Trial.” The Journal of Alternative and Complementary Medicine, vol. 6, no. 1, 2000, pp. 19–29., doi:10.1089/acm.2000.6.19.
6 Konofal, Eric, Michel Lecendreux, Isabelle Arnulf, and Marie-Christine Mouren. “Iron Deficiency in Children With Attention-Deficit/Hyperactivity Disorder.” Archives of Pediatrics & Adolescent Medicine, vol. 158, no. 12, 2004, pp. 1113.
7 Akhondzadeh, Shahin. “Zinc Sulfate as an Adjunct to Methylphenidate for the Treatment of Attention Deficit Hyperactivity Disorder in Children: A Double Blind and Randomized Trial.” BMC Psychiatry, vol. 4, no. 9, 2004, doi:10.1186/isrctn64132371.
8 Haslam, Robert, et al. “Effects of Megavitamin Therapy on Children with Attention Deficit Disorders.” Pediatrics, vol. 74, no. 1, July 1984, pp. 103–111.
9 Pelsser, Lidy M. J., et al. “A Randomised Controlled Trial Into the Effects of Food on ADHD.” European Child & Adolescent Psychiatry, vol. 18, no. 1, 2008, pp. 12–19., doi:10.1007/s00787-008-0695-7.
10 Schab, David W., and Nhi-Ha T. Trinh. “Do Artificial Food Colors Promote Hyperactivity in Children with Hyperactive Syndromes? A Meta-Analysis of Double-Blind Placebo-Controlled Trials.” Journal of Developmental & Behavioral Pediatrics, vol. 25, no. 6, 2004, pp. 423-34.
11 Dosreis, Susan, et al. “Parental Perceptions and Satisfaction with Stimulant Medication for Attention-Deficit Hyperactivity Disorder.” Journal of Developmental & Behavioral Pediatrics, vol. 24, no. 3, 2003, pp. 155–162., doi:10.1097/00004703-200306000-00004.
12 Wolraich, Mark L., et al. “Effects of Diets High in Sucrose or Aspartame on The Behavior and Cognitive Performance of Children.” New England Journal of Medicine, vol. 330, no. 5, Mar. 1994, pp. 301–307., doi:10.1056/nejm199402033300501.
13 Wolraich, M L, et al. “The Effect of Sugar on Behavior or Cognition in Children.” JAMA, vol. 274, no. 20, Nov. 1995, pp. 1617–1621.
14 Nigg, Joel T., and Kathleen Holton. “Restriction and Elimination Diets in ADHD Treatment.” Child and Adolescent Psychiatric Clinics of North America, vol. 23, no. 4, 2014, pp. 937–953., doi:10.1016/j.chc.2014.05.010.