Article written by Stella Chadwick for the Autism Eye Magazine for the Autumn 2021 edition
Over the past two decades, more than 10,000 papers have been published on ADHD and the conclusion is that there is no single cause for this condition. When supporting a child or adult with ADHD it is imperative to consider genetic predisposition, neurological make-up, nutritional factors and environmental input. When the imbalances are corrected there can be a dramatic improvement in health, concentration, and behaviour. In this article, I have focused on outlining the most common nutritional and metabolic imbalances in children with ADHD.
This is the area that is most overlooked by the mainstream and is the one area where we can have a tremendous impact. Almost all children with ADHD appear to be deficient in magnesium. This mineral plays a role in 100 enzyme systems and impacts energy production, blood sugar levels, and the immune system. Most importantly magnesium plays a key role in the production of neurotransmitters like dopamine which helps us stay focused and motivated, and serotonin which is our happy neurotransmitter and the precursor to melatonin, our sleep hormone. Ironically drugs like Ritalin, prescribed for ADHD create a deficiency in magnesium and maybe the reason why the drug doesn’t work for some children. Getting magnesium from food (see table two) is one way of ensuring adequate levels but in most cases, we need to supplement. My favourite supplements are magnesium threonate or glycinate, as they both work directly on the nervous system. Magnesium needs vitamin B6 to be absorbed in a ratio of 10:1.
Iron is fundamental for a healthy brain and in a study published in BMC Psychiatry, children with low iron were 67% more likely to develop ADHD. It’s important to check iron levels before supplementing. Getting adequate iron-rich foods (see table two) is one approach, but if levels are significantly low it is best to supplement. Measuring iron is not always enough. We need to measure ferritin which shows the storage level of iron. In a study reported in the Archives of Pediatrics and Adolescent Medicine, 84% of children with ADHD had abnormally low ferritin levels. If there is a history of gluten sensitivity in your family, have your child tested for celiac disease which may be the underlying reason for poor iron absorption. See table one for key symptoms of iron deficiency
It is estimated that more than 70% of children with ADHD have a zinc and copper imbalance. Zinc is crucial in more than 300 biochemical processes and nourishes the entire brain. Adequate copper is also necessary for our brain and our nervous system to work but when too high it can block the production of serotonin and can cause; depression, anxiety, hyperactivity, and aggressiveness. When assessing zinc and copper levels we must look at their ratio. Those with high copper to zinc ratio (this means they have too much copper in relation to zinc) tend to be the Jekyll-Hyde types with periods of very good behaviour interrupted by violent episodes followed by remorse. Those with low copper to zinc ratio (which means they have too little copper in relation to zinc) tend to be oppositional, defiant, and assaultive. Those with high copper to zinc ratio should also be tested for a condition called kryptopyrroluria (KPU). This is a genetic condition where too many pyrroles are produced in the body binding to zinc and B6 and creating a functional deficiency in both these crucial nutrients. This can be assessed through a simple inexpensive urine test. You can read more about KPU in the Winter 2016 edition of the Autism Eye magazine. Testing for zinc and copper can be done through a hair sample or blood test. To replenish zinc levels consider zinc picolinate remembering that it can take up to 6 months to balance the copper/zinc ratio. Low copper levels usually have to do with issues with the carrier protein and should be investigated. Supplementing copper in children is not advised. See table two for foods rich in copper and table one for key symptoms of iron and copper deficiency.
The trace mineral lithium is often low in children with ADHD. A child with a significant deficiency in this mineral is likely to be very turbulent, impatient, aggressive, impulsive, intrusive and unreasonable. Balancing this mineral can be like magic for some kids but it’s a tricky mineral to supplement and needs to be monitored by your medical team or a qualified practitioner. Testing is best done through a hair sample.
Every thought we have or action we make depends on healthy levels of Essential Fatty Acids (EFAs) in our brain. You may have heard of omega 3 and omega 6 fatty acids. There is evidence that children with ADHD have a 40% lower level of omega 3 fatty acids in the brain. Our ancestors ate a ratio of 2:1 of omega 6 to omega 3. Our current diet tends to be more like a ratio of 15:1 largely due to the excessive omega 6 found in baked goods, crisps, many types of frozen foods, salad addressing and so on. On average when deficient we need at least 2g of omega 3 daily to replenish the stores. It can take up to 6 months to get the levels balanced so be patient. EFA status can be assessed through a blood test. See table one for key symptoms of omega 3 deficiency.
Flavanols found in darkly pigmented fruits like blueberries and red grapes or green tea, sulforaphane, and turmeric have been shown to balance brain waves resulting in better attention and focus as well as better mood and memory recall. Using formulations containing pycnogenol, bilberry extract curcumin, green tea extract, broccoli extract or sulforaphane have been helpful in clinical practice and have good scientific data supporting their benefits. Children who are sensitive to phenols and salicylates should avoid such supplements. There is also great need for B vitamins, especially vitamins B6, B12 and folate. Their need can be assessed accurately through an urine organic acid test which we run routinely for our patients. Specific amino acids are used in our clinic with great success with speedy results, sometimes in as little as 20 minutes. For example, Tyrosine and L-theanine can be used for improving focus and GABA, L-tryptophan and 5-HTP for calming and L-glutamine for blood sugar balance. Always make sure your child has adequate vitamin D which is not only essential for healthy bones and a healthy immune system but also plays a key role in blood sugar and neurotransmitter balance, as well as mood regulation.
The link between the health of the gut and the brain has become well established over the past few years. We have more neurotransmitters in our gut than we do in our brain and 98% of our serotonin which is our feel-good hormone and the precursor to melatonin, (our sleep hormone) is made in the gut. Through functional urine and stool tests we often find bacterial and yeast overgrowth in the gut of children with ADHD, and use probiotics as well as natural anti-fungal and anti-microbial to balance the gut ecosystem. Children with a compromised gut don’t just have digestive issues but also suffer from hyperactivity, irritability, poor focus and memory, inappropriate behaviour, mood swings, and carbohydrate cravings. Once the gut is healed many of these symptoms tend to dimmish or disappear altogether.
Our brain needs glucose and uses up 20% of our entire glucose supply. Children eating a diet high in sugar are four times more likely to develop ADHD. These children also tend to be poor at processing glucose in the brain with a study finding that the uptake of glucose on the ADHD brain was significantly lower in 30 out of 60 regions of the brain. This abnormality can result in irritability, mood swings, fatigue, frustration, and depression. If there is one dietary change you make, reduce processed sugar. Keep blood sugar steady by getting your child to eat regularly, ensuring meals and snacks contain a good amount of protein and healthy fats to level out blood sugar spikes.
There are a significant number of children with ADHD who have problems digesting dairy and gluten, especially those under the age of 12. Food intolerances based on IgG levels are different to food allergies which are based on IgE levels. Both are immune markers but IgE can be swift and immediate whereas IgG can take hours and sometimes days to impact the body making it much harder to identify. Key symptoms of food sensitivity are; dark circles under the eyes, a history of colic and ear infections, eczema, poor sleep, runny nose, tummy pain, foggy brain, fatigue, irritability, moodiness, problems with speech and sound sensitivity.
Phenols and salicylates found in food colourings and additives as well as in “healthy” foods such as berries, red grapes, tomatoes, apples, citrus fruit, olive oil etc. can be a problem for some children and their avoidance forms the basis of the Feingold diet. You can read my article about this very subject in the Spring 2021 edition of the Autism Eye Magazine. Sensitivity to additives such as benzoic acid, sulphites, nitrates, and MSG is also very common in ADHD children. In many cases, once the gut health is re-established and nutrients are replenished, food sensitivities can be reduced significantly. Although avoiding all food additives and colouring is best
Biochemical differences in children with ADHD are significant and real. Once your child is on the right diet and supplement plan you may find that many of the symptoms reduce dramatically or disappear altogether. There are many other aspects of ADHD support we have not covered in this article such as therapies like neurofeedback and cognitive behavioural therapy, cranial osteopathy, and mindfulness all of which have a good evidence base but all of which need a balanced body to yield the best outcome.
|Symptoms of nutrient deficiency
|Magnesium deficiency: poor focus, irritability and anxiety, apathy, mood swings, fatigue, and poor sleep.
|Iron deficiency: poor sleep and restless leg syndromes as well as poor appetite, shortness of breath, lack of healthy energy, heart palpitations and pale skin.
|Zinc deficiency: poor appetite, digestive issues, allergies, sleep problems, white spots on nails, diarrhoea, weight loss, fatigue, low immunity, dermatitis, and visual problems.
|Copper deficiency: always feeling cold, easy bruising, fatigue, poor growth, unexplained muscle soreness, brittle bones, pale, premature grey hair, vision problems.
|Lithium deficiency: turbulent, impatient, aggressive, impulsive, intrusive, unreasonable. poor detoxifier and chronically low in B12 and folate even when supplemented
|Omega 3 fatty acid deficiency: excessive thirst, frequent urination, food allergies or intolerances, poor focus and tendency for autoimmune conditions.
Food sources of nutrients
|Source of magnesium
|Dark chocolate, avocados, nuts, legumes, seeds, whole grains bananas, leafy greens
|Source of iron
|red meat, liver and other organ meats, pumpkin seeds, spinach, broccoli, legumes, and quinoa.
|Source of Zinc
|Red meat, shellfish, turkey, sesame and pumpkin seeds, lentils, cashews and quinoa.
|Source of copper
|Sesame and sunflower seeds, cashews and walnuts, soybeans, shitake mushrooms, lentils, and chickpeas.
|Source of lithium
|Potatoes, tomatoes, cereals, cabbage, eggs, mineral and tap water.
|Sources of Omega 3 fatty acids
|Oily fish like salmon, sardines, mackerel, anchovies, herring, walnuts, flaxseeds, chia seeds and organic eggs
|Source of vitamin D
|Sun exposure, oily fish like salmon, sardines, mackerel, anchovies, herring, and organic eggs