Food Therapy: The Right Nutrition for ADHD Symptoms
Medication isn’t everything — when it comes to helping ADHD symptoms, eating well can be among the most effective forms of treatment.
The best foods for children who have ADHD are the same as those for children who don’t have the condition. All children need lots of healthy unprocessed food and generous amounts of fruits and vegetables.
The right diet — and good nutrition — is especially important for anyone with ADHD. Many children can eat relatively poorly and function pretty well at school and at home, at least in the short term. Kids with ADHD can’t.
Eating the wrong foods makes the difference between losing focus at 11 a.m. and succeeding in school. Eating the right foods makes the difference between a successful play date and one that ends in a temper tantrum. It is important for parents to pay attention to the effect that foods have on their child’s behavior and symptoms.
I have conducted nutritional interventions for hundreds of patients with ADHD during the past 24 years. In many cases, changes in nutrition have not only improved the symptoms of hyperactivity, concentration, and impulsivity, but have also calmed oppositional behavior.
Food Trends vs. Food Facts
Many books and thousands of articles are published every year about which foods you should eat to have the healthiest body and brain. And some of the advice changes from year to year. However, the basics of healthy eating are constant. Children and adults need adequate amounts of high-quality macronutrients — protein, fat, and carbs — and lots of micronutrients — vitamins, minerals, and phytonutrients from fruits and vegetables.
Protein should come from meat, fish, beans, nuts, dairy, and grains, depending on your family’s preferences. A child should get half a gram of protein each day for each pound of body weight. If your child weighs 100 pounds, he or she should consume 50 grams of protein a day. If he weighs 80 pounds, 40 grams of protein will do it. Oats and quinoa are two higher-protein grains. Collards, broccoli, and peas have higher amounts of protein than other vegetables.
Carbs should be high in fiber and low on the glycemic index (GI). The glycemic index rates carbohydrates according to their effects on blood sugar. A food that has a low GI rating lowers blood sugar levels, decreases cravings, and increases focus. Whole grains, beans, seeds, and most vegetables are good choices (see “More Carbs? No Thanks. I’ll Pass” below).
A child should consume healthy fats, a combination of polyunsaturated, monounsaturated, and saturated fat, avoiding trans fats at all costs. Although most trans fats have been eliminated or reduced in processed foods, they can be found in some items, including baked goods and french fries, in some restaurants. Any food that lists “partially hydrogenated” oil on the ingredients label contains trans fats.
These recommendations will enhance your child’s health, whether he has ADHD or not. The following suggestions are recommended for the ADHD brain specifically:
1. Avoid all artificial colors, flavors, and preservatives. Research1 has shown that these man-made chemicals can cause children without ADHD to be hyperactive and less focused. The effects are even worse for a child with ADHD. Many parents have told me that their children get out of hand when they eat red food dye or artificial sweetener.
The evidence for this is so strong that in Europe there is a warning label on foods with certain artificial colors. The warning reads: “May Have an Adverse Effect on Activity and Attention in Children.” So get rid of the Gatorade, the bright yellow cheese puffs, the multicolored candy, and the Lucky Charms cereal. It is important to read labels. A good rule of thumb is, the more ingredients on the label (unless they are spices), the more cautious you should be about buying the product.
2. Watch the sugar. Although not every child with ADHD reacts to sugar in an adverse way, it is best for all parents to limit sugar as much as possible. Soda, if offered at all, should be an occasional treat. Fruit juice should be limited to one cup a day at most. Whole fruit, on the other hand, is perfectly fine.
3. Breakfast is key, and lunch is almost as important. Children with ADHD should eat a breakfast with generous amounts of protein and healthy fat, and avoid highly processed carbohydrates and sugar. Good breakfast foods include oatmeal, whole-grain cereals, whole-grain toast with peanut or almond butter, high-protein yogurt with nuts and fruit, or some type of breakfast meat that is nitrite- and nitrate-free. (Some natural food companies offer chicken or turkey sausage without preservatives.)
Don’t forget leftovers. A bean-and-cheese burrito from last night’s dinner works well for breakfast. Protein and fat are important because they slow digestion; the fiber in whole foods does the same thing. Adding nuts or seeds to breakfast foods is always a good idea, because they contain protein and healthy fats. If your child is a picky eater, I recommend smoothies for breakfast, because you can hide healthy foods in them that are camouflaged by great taste.
The breakfast principles also apply to lunch — whole foods, some protein, fewer processed carbs. There is nothing wrong with a cheese or meat sandwich on lower-sodium, whole-grain bread. Kids with more adventurous taste can try hummus on pita bread for lunch. Adding fruits and vegetables is a good idea. Carrots, celery sticks, and apple or pear slices are good, but any fruit or vegetable your child likes is fine. Several kids in my practice love kale chips, which are healthy. Nuts are a great snack. Some nutrition bars are good, such as Lara or Clif bars.
Many of you are probably thinking, “Easy for you to say, Sandy, but how I do get my child to eat this stuff?” This is a challenge for parents, but remember that you are in charge of what your child eats. I like to quote Ellyn Satter, M.S., RDN, a well-known feeding therapist: “Parents are responsible for what they offer their child to eat. Children are responsible for whether they eat it or not.”
Give your child a choice of healthy foods. If she chooses not to eat them, she will get hungry. I have never seen a child with ADHD starve. She may miss a meal, but she will eat the next one. You will be amazed at how quickly a child will adapt if you are consistent and firm.
Here’s an example: Billy likes waffles with syrup for breakfast. Tell him this is no longer an option. Give him a choice of oatmeal or toast with peanut butter and a glass of milk. If he refuses, then he does not eat breakfast that day. It will not be long before he gets hungry and chooses one of the options he is offered.
4. Eat organic foods. Organic foods don’t have more nutrition than non-organic foods, but they do not have the pesticides, hormones, and other additives that have been linked to ADHD. In a study2 of 1,100 children, those with higher levels of pesticides in their urine were twice as likely to have ADHD. Eating organic fruits and vegetables cuts pesticide levels by 80 percent. Going organic can be difficult and expensive, but reasonably priced organic foods are available at Walmart, Costco, and Trader Joe’s.
Some fruits and vegetables have higher pesticide levels than others. You can find a list of the best and worst fruits and vegetables at ewg.org/foodnews/list.php. Do your best to avoid those that are high on the list.
People often ask me about genetically modified foods. At this point, I suspect that genetically modified foods may not be good for your health, but there isn’t sufficient research linking them to ADHD. So, if you can avoid these types of foods, do it. There are increasing numbers of non-GMO foods in the supermarket.
5. Serve healthy carbs. The primary function of carbohydrates is to provide energy for the body and especially the brain and nervous system. Eating the wrong kinds of carbs — from foods high in sugar and without fiber, vitamins, and minerals — will cause your child’s brain to become foggy and to lose focus. Luckily, there are lots of healthy carbohydrates to choose from. Carrots, eggplant, green beans, peppers, lettuce, tomatoes, peanuts, and walnuts are excellent examples of healthy carbs. Lentils and all types of beans, peas, egg noodles, whole wheat pasta, bran cereal, brown rice, rolled oats, milk, grapefruit, and apples are also good choices. If you have a picky eater, you can hide a lot of these healthy carbs in soups and chili.
6. Eat a combination of healthy fats. Over the last few decades, fat has become a bad word. Yet over the same time period, Americans have cut their fat intake, substituted unhealthy carbohydrates, and gained weight. Healthy fats are good for body and brain. I recommend using olive, canola, or high-oleic safflower oil, which are high in monounsaturated fats. Saturated fats, found in meat, eggs, and dairy, may not be as harmful as previously thought. The jury is still out on that, but a reasonable amount of saturated fat is OK.
Most important, make sure your child gets enough omega-3 fatty acids, a specific type of polyunsaturated fat. They are crucial for brain function and are often in short supply in children with ADHD. I find that most children do not get enough omega-3s, and I strongly encourage a fish oil supplement for almost all children with ADHD.
7. Eat lots of fruits and vegetables, aiming for at least six servings a day. It is difficult to get your child to eat these foods, but it is worth the effort. It has been shown that many children with ADHD have lower levels of antioxidants. A multivitamin/multimineral supplement can fill some of the gaps, but they cannot provide all of the phytochemicals found in fruits and vegetables.
You may be surprised at the positive changes you see in your child after you institute this nutritional plan. You don’t have to change your family’s eating habits all at once. Change it gradually but steadily. And remember that everyone needs treats sometimes. Your child is not going to suffer from having an occasional soda or piece of birthday cake. It can be counterproductive to be too rigid. Good luck — and good eating!
Sandy Newmark, M.D., is a member of the ADDitude ADHD Specialist Panel.
“More Carbs? No, Thanks. I’ll Pass”
I was in central Oregon, lecturing to mental-health professionals about ADHD. When I walked into the large hall, my heart sank as I saw the food in the back of the room. On a table were boxes of muffins, donuts, bagels, and cinnamon rolls. I started my lecture, talking about the food in the back of the room. “Those foods are good examples of what parents unknowingly do that makes kids struggle in school. They start the day with muffins, donuts, or sugary cereals. They get virtually no protein in the morning. No wonder teachers complain that so many kids cannot concentrate.” For most people with ADHD, the right way to eat is a higher-protein, higher-healthy-fat, lower-simple-carbohydrate diet.
The right food plan can decrease the amount of ADHD medication needed. Joseph Egger reported3 in the British medical journal, The Lancet, that 116 of 185 hyperactive children had a positive response to a low-allergen diet (higher in protein and lower in simple carbohydrates) supplemented by calcium, zinc, magnesium, and vitamins. When I can convince my patients to eat this way, they notice better mood stability, focus, and stamina, as well as less distractibility, tiredness in the late morning and mid-afternoon, and less craving for sugary substances. In some cases, the right foods can be the primary treatment for ADHD.
-DANIEL G. AMEN, M.D., excerpted from Healing ADD: The Breakthrough Program that Allows You to See and Heal the 7 Types of ADD. Copyright 2013.
Daniel Amen, M.D., is a member of the ADDitude ADHD Specialist Panel.
1 Mccann, Donna, et al. “Food Additives and Hyperactive Behaviour in 3-Year-Old and 8/9-Year-Old Children in the Community: A Randomised, Double-Blinded, Placebo-Controlled Trial.” The Lancet, vol. 370, no. 9598, 2007, pp. 1560–1567., doi:10.1016/s0140-6736(07)61306-3.
2 Bouchard, M. F., et al. “Attention-Deficit/Hyperactivity Disorder and Urinary Metabolites of Organophosphate Pesticides.” Pediatrics, vol. 125, no. 6, 2010, doi:10.1542/peds.2009-3058.
3 Pelsser, Lidy M, et al. “Effects of a Restricted Elimination Food Plan on the Behaviour of Children with Attention-Deficit Hyperactivity Disorder (INCA Study): A Randomised Controlled Trial.” The Lancet, vol. 377, no. 9764, 2011, pp. 494–503., doi:10.1016/s0140-6736(10)62227-1.