Does Eating Healthy Help ADHD? Not Necessarily, But Everyone’s Trying It.
Among all the natural treatments for ADHD — exercise, behavioral therapy, neurofeedback, nutrition changes, and more — eating healthy is one of the most popular among ADDitude readers. The problem? The research is inconclusive, and keeping a close watch on what you and your family eat is incredibly hard.
Nutrition is critical to our well being and health — to our brains and our bodies. But is eating healthy, specifically, a strategy for improving ADHD symptoms like hyperactivity, inattention, and impulsivity? In short, there is limited evidence to suggest so.
Despite a dearth of scientific consensus, implementing an “ADHD-friendly” nutrition plan is among the most popular natural treatment approaches among ADDitude readers, according to a 2017 survey of 4,000 adults and parents of children with ADHD. Roughly one quarter of survey respondents reported that they used dietary strategies ranging from avoiding sugars and artificial colors, to increasing protein, and following an elimination diet to try to treat ADHD symptoms.
Many respondents reported improvements in ADHD symptoms after making nutritional changes, but a great majority noted that changes in diet were only somewhat effective in addressing symptoms, despite their serious attempts to implement an ADHD nutrition plan.
Regardless of whether they saw positive results, nearly all survey respondents agreed: Eating healthy is hard, especially when your ADHD brain craves dopamine (i.e. sugar and carbs), when your child is a picky eater, when your appetite is suppressed by other treatments, when your child is sensitive to food textures, when your food budget is limited, when you’re a busy and/or single parent with scant time for grocery shopping, and when life gets in the way.
Popular books and articles offering ‘quick and easy fixes’ do nothing to help when these ADHD realities get in the way. In fact, they can do more harm than good but ratcheting up the guilt:
- “Enforcing an ADHD diet was awful,” one parent wrote. “It became a full time job to plan, maintain, shop for, etc. and there were no positive results to observe.”
- One adult reader wrote: “It was very helpful, but medication was still needed to manage behavior, and it was very restrictive and hard to maintain the diet. Small mistakes in eating would ruin all the hard work.”
- “It was extremely difficult because the foods we were trying to avoid were the ones she craved and would eat,” another parent wrote. “She had such a poor appetite at times that we would give in just to get her to eat anything.”
It’s true that dietary changes may improve symptoms in some cases, but eating healthy is not a guaranteed cure for ADHD by any stretch. Research confirms that nutrition is no substitute for medication and other proven therapies.
Eating Healthy by Cutting Sugar
Reducing sugar consumption was the most commonly-used approach by surveyed adults with ADHD and the second most common among caregivers. Many people with ADHD believe that sugar causes hyperactivity, inattention, and sluggishness, though the science here is thin.
“Sugar increases my fidgeting and my inability to pay attention,” wrote one adult survey-taker. Another said, “I have noticed a sharp decrease in my ability to focus when I drink beverages with processed sugar.” Parents of children with ADHD observed that consuming too much sugar contributed to their kids’ poor focus, and triggered hyperactivity, irritability, and “off the rails” behavior.
Some ADDitude readers found that decreasing sugar intake made a significant improvement in ADHD symptoms. Lowering sugar “keeps my energy levels even,” one person wrote, “which allows me to have sustained focus and concentration.” One parent reported that “limiting sugar helps with [my child’s] moodiness and impulsivity.”
Many people who cut back on sugar in their diets often replace it with artificial sweeteners, but this was not the case with a lot of those surveyed. Instead, they avoided artificial sweeteners for the same reasons they avoided sugar. “I had better focus and better sleep after removing artificial sweeteners,” one person explained.
The hard reality of cutting sugar, however, was yet another struggle:
- “Sugar is a struggle to cut out,” one parent wrote to ADDitude. “Eliminating it makes my child very unhappy.”
- “Too hard to stay off sugar now — but will retry someday,” an adult survey-taker wrote.
- “It is very difficult for my child to stay away from sugar, but I definitely see behavioral changes when he has sugar” another parent wrote.
What Does Research Say About Sugar and ADHD?
Though many of the adults and caregivers surveyed seem convinced of sugar’s detrimental effects on ADHD symptoms, research on the topic is less black and white.
Researchers even found in one study that parents rated their children as more hyperactive when told they were given sugar, regardless of whether they actually ate any sugar.5 A 2011 study, moreover, examined available research and concluded that “the inability to document an effect of added sugars on hyperactivity…has largely discredited the sugar hypothesis of ADHD.”6
This is not to say that sugar doesn’t have an effect on the body. It is well documented that diets high in excess sugar are associated with a greater risk of illnesses and unhealthy outcomes, including cardiovascular diseases, weight gain, diabetes and more7. Keeping sugar intake at healthy levels, therefore, is beneficial for all.
Eating Healthy by Increasing Protein
Protein is an essential macronutrient for healthy functioning of mind and body, one that is important to growth and development in children.
Many ADDitude readers who were surveyed reported that protein consumption optimizes the brain and sustains energy levels through the day. One survey respondent said that increasing protein consumption kept her child’s “extreme reactions more even.” Another parent noted that increasing protein while reducing sugar was a good strategy.
Most readers surveyed felt that a high-protein breakfast was critical to sustained focus during the school day. One parent saw a discernible “difference in behavior” in his son during the week, compared to weekends, when his diet is more lenient.
For one adult, increasing protein was a game changer. “It helps me maintain more stable blood sugar levels, which curbs impulsive behavior,” he said. Another survey-taker said that protein “offsets the midday crash and helps keep me and my family level throughout the day.” The relationship between protein and sugar was summed up by an adult survey-taker: “High protein and low sugar help my brain function at its best.”
Many survey-takers, however, also spoke to the difficulties in working in more protein in their diets.
- “When I do increase my protein, and eat fewer carbohydrates, it is very effective,” one adult wrote. “I just struggle with doing it for any significant length of time.”
- I think high protein with low unhealthy sugars is a healthy eating approach, [but] ADD people are notoriously bad at meal planning,” one parent wrote.
The Science on Protein and ADHD
Although some evidence supports the benefit of protein in treating ADHD symptoms and improving cognitive performance, more research is needed.
Some research, for instance, has suggested that a high-protein diet, especially a high-protein breakfast, can help with focus, mood, and alertness8. One study also found that a higher protein breakfast, compared to a high-carb one, was associated with better memory.9
Eliminating Artificial Dyes to Reduce Impulsivity
Many adults and caregivers surveyed worked to maintain diets with natural foods and avoided artificial colors and dyes. In fact, decreasing or eliminating artificial colors and dyes was the most common diet and nutrition approach among caregivers of children with ADHD, one pursued by 70 percent of survey respondents. Many parents reported that foods with artificial dyes worsened their children’s hyperactivity and irritability. One parent wrote, “When my son eats sugar, artificial colors, and junk food, his impulsivity is just around the corner.”
A dye-free diet, according to a number of parents, had dramatic and positive effects on their children. “When we removed artificial dyes, our child slept through the night, for the first time ever,” one parent said. “Food dyes changed [my daughter’s] personality,” another parent noted. By eliminating them, her behavior changed for the better.
Some parents singled out red dye as the culprit, saying, in one case, that red dye contributed to his child’s aggression and impulsivity. Just as many parents reported the negative effects of dyes on their children, many adults surveyed noted that eliminating foods with dyes had a positive effect on their mood.
But avoiding artificial dyes seemed impossible for many parents and adults, who lamented their near universal presence in foods. As one parent wrote:
- “We noticed a definite improvement when attempting to eliminate artificial colors and dyes.That being said, as our son grew older and was involved in school, church parties, and spent time with friends, we no longer had direct and total control over the foods and drinks he consumed. We have learned that restaurants, schools, churches, and even friend’s families don’t adhere to the same standards, and it feels like we are fighting a losing battle.”
The Research on Artificial Dyes
Recent studies have suggested an adverse relationship between hyperactivity and food dyes in children with and without ADHD.10 11 These studies even spurred changes in the United Kingdom’s policies toward food dyes, and prompted the FDA to hold hearings in 2011 on the subject.12 Similar action, however, was not taken in the U.S. due to what the FDA deems a lack of unequivocal evidence on food dyes.
A 2012 analysis13, however, of more than 30 restriction diets (characterized mainly by the elimination of food dyes and other additives) concluded that about 30 percent of children with ADHD are responsive to them, and that as many as 8 percent of them have symptoms related to food colors. Referring to the FDA’s hearings, the researchers agreed that the current evidence is “too weak to justify action recommendations,” but is “too substantial to dismiss.”
A 2014 review14 of restriction and elimination diets in ADHD treatment said that the contrast between the few studies on the topic and the wide interest in the topic is striking. Needed are fresh contemporary trials of elimination diets with well-controlled double-blind procedures as were pioneered decades ago,” the review concluded.
Eating Healthy with the Feingold Diet
Several parents surveyed were enthusiastic about the effect of the Feingold diet on their children with ADHD. This well-known elimination diet, popularized in the 1970s by Benjamin Feingold, M.D., aims to decrease ADHD symptoms by eliminating artificial colorings, flavorings, and salicylates (naturally occurring compounds found in some fruits and vegetables). Dr. Feingold believed that some people with ADHD are sensitive to these foods, and that eliminating them will improve behavior.
While many studies and reviews have found little to no substance to Feingold’s theory, his diet has remained popular over the years.15 Survey responses from parents are a testament to the diet’s enduring influence, and may point to recent insights about the relationship between artificial dyes and ADHD.
“Within three months of starting the Feingold diet, my son’s medication needs decreased dramatically,” one parent wrote. “He went from taking 40 mg. of Vyvanse, clonidine, and allergy meds to less than 20 mg. of Vyvanse and no other meds. Sleep and allergy problems went away.”
Another survey-taker said that the diet was “life changing. The entire family eats that way now, after seeing the effect it has on our child.”
As with cutting sugar and dyes and increasing protein, sticking to the Feingold diet was no easy task. Parents wrote that:
- “Feingold seemed to work, but it was too hard to maintain.”
- “It isn’t always easy to follow a diet like Feingold, but it isn’t too bad after the first learning curve.”
Does the Feingold Diet Actually Work?
Recent research suggests that skepticism over the Feingold diet stems from outdated studies, and that new reviews, like the studies on artificial dyes that changed the U.K.’s policies, take a more nuanced understanding of synthetic food coloring and its effect on ADHD symptoms.16
Other Dietary Approaches for ADHD
Caregivers and adults surveyed also tried reducing dairy foods and gluten from their diets. “Eliminating gluten took our situation from unmanageable and crazy to functional,” one parent said.
A reduction in dairy and gluten, for one adult survey-taker, led to a “decrease in foggy brain and moodiness.”
For at least one parent, gluten was described as the single missing piece to a perfect ADHD nutrition plan. “This was the most difficult to do based on my daughter’s palate and food desires,” they wrote. ” Without that being eliminated, I feel the nutritional plan as a treatment tool had limitations.”
Research, however, hasn’t found conclusive evidence linking ADHD and gluten sensitivities, though they can co-occur. A 2016 study even advised against implementing a gluten-free diet to treat ADHD.17
The Bottom Line on Eating Healthy to Help ADHD
Though many adults and parents in the survey recommended a nutrition plan for managing ADHD symptoms, they also generally concluded that these approaches were only marginally effective for treating ADHD. The struggle to maintain ADHD-friendly nutrition also influenced results, with many concluding that an “ADHD diet” was not worth the effort:
- “We didn’t see much improvement with any diet changes, which are hard to maintain across environments and lifestyles,” one parent wrote.
- “Limiting diet is extremely hard,” one adult wrote. “You want to be able to eat the way you used to. But I feel better off off these items.”
- “I don’t think we gave it enough of a chance to make a difference,” another parent wrote. “It was really hard keeping non-compliant foods away from him during school or when he was at a party, etc. It’s expensive and not an easy thing to maintain.”
Still, according to small follow-up surveys conducted by ADDitude, adults and caregivers remain interested in using a diet and nutrition plan for ADHD after doing their own research on the topic. Researchers recognize the public’s strong interest in using dietary approaches, and stress the need for more and frequent analysis of the ADHD-nutrition link.18
“Using some of these nutritional approaches may help some people, not everyone,” says Joel Nigg, Ph.D., author of Getting Ahead of ADHD (#CommissionsEarned) and professor of psychiatry, pediatrics, and behavioral neuroscience at the Oregon Health & Science University. “But the nutrition strategies need to be combined with standard care for ADHD, such as ADHD medication.”
1Prinz, R. J., Roberts, W. A., & Hantman, E. (1980). Dietary correlates of hyperactive behavior in children. Journal of Consulting and Clinical Psychology, 48(6), 760–769. Retrieved from: https://doi.org/10.1037/0022-006X.48.6.760
2 Jones, Timothy W. et al. (1995). Enhanced adrenomedullary response and increased susceptibility to neuroglycopenia: Mechanisms underlying the adverse effects of sugar ingestion in healthy children. The Journal of Pediatrics, Volume 126, Issue 2, 171 – 177. Retrieved from: https://www.jpeds.com/article/S0022-3476(95)70541-4/fulltext
3 White, J., Wolraich, M. (1995) Effect of sugar on behavior and mental performance. The American Journal of Clinical Nutrition, Volume 62, Issue 1, Pages 242S–247S. Retrieved from: https://doi.org/10.1093/ajcn/62.1.242S
4 Wolraich, M., Milich,R., et al. (1985). Effects of sucrose ingestion on the behavior of hyperactive boys. The Journal of Pediatrics. Volume 106, Issue 4, Pages 675-682. Retrieved from: https://doi.org/10.1016/S0022-3476(85)80102-5
6 Johnson, R., Gold, M., et. al. (2011). Attention-Deficit/Hyperactivity Disorder: Is it Time to Reappraise the Role of Sugar Consumption? Postgraduate Medicine, 123:5, 39-49, DOI: 10.3810/pgm.2011.09.2458
7 Yang, Q., Zhang, Z., Gregg, E.W., et al. (2014). Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med.74(4):516–524. doi:https://doi.org/10.1001/jamainternmed.2013.13563
8 Zeng, Y. , Li, S. , Xiong, G. , Su, H. and Wan, J. (2011) Influences of protein to energy ratios in breakfast on mood, alertness and attention in the healthy undergraduate students. Health, 3, 383-393. doi: 10.4236/health.2011.36065.
9 Nabb, S., Benton, D. (2006): The influence on cognition of the interaction between the macro-nutrient content of breakfast and glucose tolerance. Physiology & Behavior. 87:16–23. https://doi.org/10.1016/j.physbeh.2005.08.034
10 Bateman B., Warner J., Hutchinson E., et al. (2004). The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Archives of Disease in Childhood, 89:506-511. Retrieved from: https://adc.bmj.com/content/89/6/506
11Mccann, Donna, et al. (2007). 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, pp. 1560–1567. Retrieved from: doi:10.1016/s0140-6736(07)61306-3.
12 Arnold, L. E., Lofthouse, N., & Hurt, E. (2012). Artificial food colors and attention-deficit/hyperactivity symptoms: conclusions to dye for. Neurotherapeutics : The journal of the American Society for Experimental NeuroTherapeutics, 9(3), 599–609. doi:10.1007/s13311-012-0133-x
13 Nigg, J. T., Lewis, K., Edinger, T., & Falk, M. (2012). Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 86–97.e8. doi:10.1016/j.jaac.2011.10.015
15 Arnold, L. E., Lofthouse, N., & Hurt, E. (2012). Artificial food colors and attention-deficit/hyperactivity symptoms: conclusions to dye for. Neurotherapeutics : The journal of the American Society for Experimental NeuroTherapeutics, 9(3), 599–609. doi:10.1007/s13311-012-0133-x
16 Nigg, J. T., Lewis, K., Edinger, T., & Falk, M. (2012). Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 86–97.e8. doi:10.1016/j.jaac.2011.10.015
17 Ertürk, E., Wouters, S., Imeraj, L., & Lampo, A. (2016). Association of ADHD and Celiac Disease: What Is the Evidence? A Systematic Review of the Literature. Journal of Attention Disorders. https://doi.org/10.1177/1087054715611493
18 Nigg, J. T., Lewis, K., Edinger, T., & Falk, M. (2012). Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 86–97.e8. doi:10.1016/j.jaac.2011.10.015
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Updated on October 15, 2020