Diet and ADHD: A new frontier?
Monday, February 25, 2008
The debate has been raging for years: Can diet influence behavior, specifically ADHD? Treating a child with attention deficit hyperactivity disorder with medications and behavioral therapy alone is the norm. But could diet also make a difference?
The Feingold Diet, popular in the 1970s, eliminated artificially added colors, flavors and preservatives and dietary salicylates on the theory that many children are sensitive to these substances and that eliminating them could improve learning and behavioral problems. Although many parents were convinced it helped their children, good research studies were lacking.
Sugars have also been blamed for hyperactivity. But Dr. John N. Blair, director of the Dreyer Medical Clinic’s ADD Clinic in Aurora, says the results are mixed. "In certain children excessive sugar causes hyperactivity. In other children sugar seems to calm them down."
Carol Ann Brannon, MS, RD, of Duluth, Ga., is a mother of four, two of whom have ADHD. She specializes in nutrition therapy for children with autism and ADHD. "The biggest misconception is that stimulant medication is a cure, that medication can alleviate all the symptoms, impulsive and hyperactive behaviors and inattention. Medication is only one piece of the management of ADHD."
The research she uncovered challenged her to think differently and to emphasize what food to eat rather than what food to avoid.
She discovered many children, with or without ADHD, are lacking in nutrients, especially omega-3 fatty acids. "Some children with ADHD have responded favorably to a diet relatively sugar-free, low in simple carbohydrates, moderate in complex carbohydrates and relatively high in protein. Most evidence is anecdotal, but more parents are reporting that dietary changes can have a calming effect and improve learning," she says.
Fish oilPreliminary research suggests that fish oil supplements may help. In a pilot study in Massachusetts reported last year in the Nutrition Journal, researchers found that high doses of EPA/DHA concentrates (an omega-3 supplement formula) significantly improved behavior. And in a University of Pittsburgh Medical Center study, researchers found a correlation between higher blood levels of omega-3 fats and fewer impulsive behaviors. More research needs to be done.
Colors and additivesArtificial food colors and additives may play a role. In the first well-designed study to demonstrate a link between artificial ingredients and hyperactivity in children published last year in The Lancet, British researchers found that artificial food colors and the preservative sodium benzoate, in the amount equivalent to that in one or two servings of candy a day, appeared to exacerbate hyperactive behavior and shorter attention spans in children. The younger the child, the bigger the response. The researchers could not identify exactly which of the food additives or colors were responsible.
Correcting iron deficiency
Even the mineral iron may play a behavioral role. In a small study published this year in Pediatric Neurology, French researchers found that iron deficient, non-anemic children who received iron supplements experienced improved behaviors compared to the placebo group.
What to think?
Blair is guardedly optimistic about diet and dietary supplements. He advises a common sense approach such as a healthy balanced diet and exercise. "We specifically recommend avoiding too much sugar, diet colas and regular colas (caffeine) and any foods that aggravate the individual’s hyperactivity. We have an obesity problem in America and all children need to be on a healthier diet and exercise regimen whether they have hyperactivity or not."
As we learn more, successfully treating a child with ADHD may also include diet therapy in addition to the traditional approach.
Crunchy tuna pita pockets
n 1 large wheat pita, cut in half
n 1 (6-ounce) can tuna, packed in water
n 1 Tablespoon light mayonnaise
n 1 teaspoon Dijon mustardn 2 Tablespoons water chestnuts,
choppedn Shredded cheese, diced tomatoes,
or lettuce (optional)
Cut and open the pita pockets. In a medium bowl, combine the tuna, mayonnaise, mustard and water chestnuts. Fill each pocket equally. This sandwich can be served warm or cold. If desired, add diced tomatoes and top with shredded cheese or lettuce. Makes 2 servings.
Nutrient content per serving: 224 calories, 26 grams protein, 19 grams carbohydrates, 3 grams fat, 56 milligrams cholesterol, 1 gram fiber, 30 milligrams calcium. Adapted from Quick Meal Solutions, 2007, by Sandra K. Nissenberg, MS, RD, Margaret Bogle, Ph.D, RD, Audrey Wright, MS. Reprinted with the permission of John Wiley & Sons Inc.
Dear Good Sense Eating: What are some healthy eating tips for my child with ADHD?
Diane P., Orland Park
n Make breakfast a priority. Include a serving of a whole grain cereal, bread, pancake or waffle, fruit, low-fat or skim milk and a protein (omega-3 enriched egg, natural peanut butter, etc).
n Include protein at every meal and snack.
n Make water the beverage of choice. Avoid sugary drinks and soft drinks; limit juice intake. For natural "vitamin" water, add sliced citrus fruit or berries to a pitcher of water.
n Read food labels. Avoid foods containing trans fats and artificial food additives and colorings, especially red and yellow dyes.
n Focus on "whole" foods rather than processed or refined foods.
n Avoid caffeine.
Christine M. Palumbo is a registered dietitian in private practice in Naperville and the mother of three. She can be reached at (630) 369-8495.