Attention deficit hyperactivity disorder (ADHD) is defined as the combination of inattentive,hyperactive-active and impulsive behavior,which are severe, developmentally inappropriate, and impair function at home and in school. Common features include mood swings, anxiety, impulsivity, hostility, poor concentration and sleeping disorders, along with physical com-plaints such as headaches, migraines, and stomach upsets. ADHD individuals are also more likely to have been of low birth weight and to have allergies or autoimmune problems. Proportionally more males than females are affected, with inattention tending to be a more female trait and hyperactivity more com-mon in males.

ADHD diet

ADHD diet

ADHD does persist into adulthood, although symptoms tend to diminish with time, but the main focus relates to the problems of children with ADHD. Growing children are especially vulnerable to nutri- tional and environmental factors that influence brain development and function, which can have either a negative or a positive impact. The symptoms of this difficult condition can also significantly compromise their education, making them challenging to teach and consequently having a deleterious effect on their life-potential. The daily challenges of living with ADHD place a huge strain on families and reduces overall quality of life for all involved.

Origins

Back in 1981, Colquhoun and Bunday undertook a comprehensive survey of children with ADHD and discovered that many showed physical signs of essential fatty acid (EFA) deficiency, including excessive thirst, polyuria, dry hair and skin. These authors were the first to propose that fatty acid deficiency may be a factor in ADHD, and their groundbreaking work prompted more research studies and clinical trials designed to increase understanding of those nutritional factors involved in ADHD.

It has now been proposed that many developmental and psychiatric conditions, including ADHD along with dyslexia, dyspraxia, autism, depression, and schizophrenia, may involve deficiencies of certain long-chained fats, especially eicosapentaenoic acid ( EPA) and docosahexaenoic acid (DHA). Both iron deficiency and zinc deficiency have also been associated with the development of ADHD.

Description

Dietary Fats

Fats have a fundamental structural and functional role in the brain and central nervous system (CNS) and are a key factor in the development ADHD. The two fats that are thought to be especially important are EPA and DHA, not only because of their role in the brain and body but because of the relative lack of them in many people’s diets. EPA is the precursor of a complex group of substances, called eicosanoids,

which perform numerous regulatory functions in the brain and body. DHA is a major ‘building block’ of brain and neuronal membranes and as such has a profound influence on cell signaling. Both EPA and DHA are omega-3 fats and can be made from the omega-3 essential fatty acid, alpha linolenic acid (ALA). However, this conversion process can be problematic as genetic and environmental factors, including diet, can cause great variation in an individual’s constitutional ability to convert ALA into EPA and DHA. Dietary factors known to adversely affect this conversion include low intakes of ALA, high intakes of omega-6 fats, saturated fat, hydrogenated fat and alcohol, in addition to vitamin and mineral deficiencies, testosterone and stress hormones. Unfortunately, many dietary surveys have revealed that a typical modern-day diet is rich in omega-6 fats, saturated fats and hydrogenated fats and often low in omega-3 fats and micronutrients. ADHD children are often found to be deficient in iron and zinc and the fact that more boys than girls tend to be affected may be partly explained by the negative effect of testosterone on this conversion process. In order to avoid a functional deficiency of these important fats, the diet should have a smaller ratio of the omega-6 essential fat, linoleic acid (LA) to omega-3 essential fat (ALA), at an ideal ratio of no more than 5:1, as well as adequate amounts of pre-formed EPA and DHA. The richest dietary sources of LA are certain vegetable and seed oils, including sunflower, saf-flower, soya, palm, peanut and sesame, all of which should be eaten in good amounts along with oils that are rich in ALA such as rapeseed (canola), flaxseed (linseed) and walnut oil. Olive oil is also recommended, despite having quite a low ALA content, as it is rich in beneficial monounsaturated fats. Looking at types of spreading fat available, many margarines have been specifically formulated to be rich in ALA, although some brands still contain harmful hydrogenated fats, but it is worth remembering that butter actually has a low LA content and when mixed with equal quantities of rapeseed or olive oil, the saturated fat content is much reduced. Other sources of ALA include green, leafy vegetables such as rocket, watercress and spinach as well as fresh green herbs, such as basil, coriander, mint and parsley. Consequently, the food products of animals allowed to graze on open pasture will also be rich in ALA and so organic, free-range and outdoor-reared meat, milk and eggs are the best choice. When it comes to sources of EPA and DHA, fish and seafood are the best sources with oily fish , such as salmon, trout, mackerel, sardines, herring and ancho- vies, being especially rich. Fresh tuna is classed as an oily fish but the canning process causes a significant loss of fatty acids so tinned tuna has an EPA and DHA content comparable to white fish, such as cod, had- dock and plaice. Certain varieties of fish are more

likely to contain large amounts of pollutants such as mercury and lead which are known to be neurotoxic and so it is prudent for people with ADHD, and all children under 16 years of age, to avoid eating shark, marlin and swordfish. DHA can also be found in liver and egg yolks and so these foods should be incorpo- rated into the diet regularly, unless you are taking a nutritional supplement that contains vitamin A in which case you should not eat liver or foods containing liver such as pate

A general recommendation of a combined daily dose of 500 mg EPA and DHA is needed to avoid functional deficiency of these important fats, although individuals with ADHD may have an even higher requirement. This weekly total of 3,500 mg is the equivalent of 3 portions of salmon every week. In the UK, the recommended amount per week for girls and women of childbearing age is two and for boys, men, and women past childbearing age is four. The relative amounts of EPA and DHA does vary greatly between varieties of fish , with mackerel providing 2700 mg per average portion and haddock providing a much lower 170 mg for a medium sized fillet. For many people this variability in EPA and DHA intake is unlikely to have significant consequences as long as fish is regularly consumed, but for individuals with ADHD it may compromise brain function. For this reason pure fish oil supplements that provide a daily standard dose of EPA and DHA are useful in addition to a diet containing fish and seafood. Increasing evidence from well-designed clinical trials have indeed shown that supplementation with EPA and DHA alleviate ADHD-related symptoms in some children.

These supplements also have the advantage of being relatively safe and offering general health benefits, specifically in terms of cardiovascular protection. Although pure fish oil supplements may be beneficial in some individuals with ADHD it is important to note that more research needs to be done to fully establish the durability of any treatment effects as well as opti-mal dosages and formulations.

Dietary Antioxidants If intakes of long-chained polyunsaturated fats (PUFAs), such as EPA and DHA, increase then so does the risk of lipid peroxidation by the action of harmful free radicals, smoking, and pollutants, etc.; substances produced in the body by normal processes such as breathing and metabolism. PUFAs are highly susceptible to attack from these reactive substances and need the protection of antioxidants to avoid get- ting damaged and thus affecting the structure of the lipid membranes of the brain and CNS. When free radical production is insufficiently countered by anti- oxidants the resultant damage to the brain and body is termed ’oxidative injury’.

Dietary antioxidants include nutrients such as vitamin E and selenium as well as biologically active substances such as flavonols, anthocyanins and caro- tenoids, found in highly colored fruits and vegetables, nuts, tea and red wine. Vitamin E is naturally found in PUFA-rich foods like oils and nuts whilst selenium is found in fish, seafood, liver, egg, brazil nuts, mush- rooms and lentils. Eating the recommended daily min- imum of 5 portions of fruit and / or vegetables should provide adequate amounts of complementary dietary antioxidants, especially if a wide range of colors and varieties are chosen.

Dietary Iron

Iron deficiency has been associated with ADHD in children and tends to be worse even when compared with iron-deficient non-ADHD controls. Lower serum ferritin levels correlate with more severe ADHD symp-toms and greater cognitive deficits.

Dietary sources of iron include red meat, fortified breakfast cereals, pulses and dried apricots and these foods should feature regularly in the ADHD diet.

Additional supplementary iron may be required in cases of proven iron deficiency.

Dietary Zinc

Zinc has a range of important functions in the body, including the metabolism of neurotransmitters and fatty acids, with zinc deficiency possibly having an effect on the development of ADHD. Children with ADHD who have been treated with supplementary zinc have exhibited reduced hyperactive, impulsive and impaired-socialisation symptoms.

Foods known to be rich in zinc include seafood, liver, pine nuts, cashew nuts and wholegrain cere- als and so should be eaten regularly to help avoid deficiency.

Synthetic Food Additives

Certain synthetic food colorings, flavorings and preservatives, have been linked to increase hyperactivity in some ADHD and non-ADHD children. Many of these additives are unnecessary and are frequently used to sell poor-quality foods, that are often mar-keted specifically at children.

The following additives have been implicated in adverse reactions:

·         E102

·         E104

·         107

·         E110

·         E122

·         E123

·         E124

·         128

·         133

·         E142

·         E150

·         E151

·         E154

·         E155

·         E180

·         E220

·         E221

·         E222

·         E223

·         E224

·         E226

·         E227

·         E228

·         benzoic acid

·         sodium benzoate

·         sodium metabisulphite

·         sulphur dioxide

·         vanillin

Function

The ADHD diet works by providing the right type and amount of fats needed for the brain and CNS as well as providing sufficient amounts of iron and zinc to avoid nutritional deficiencies that are known to be associated with worsening ADHD symptoms. Nutri-tional supplements should be taken upon the advice of a Doctor or Dietitian and taken in addition to a healthy, balanced diet. Dietary provision of antioxidants are needed to protect the long-chained fats from breakdown which would affect brain structure and compromise signalling within the brain and CNS. Finally, the ADHD diet excludes those synthetic  food additives that have been identified as having the potential to adversely affect the behavior of ADHD, and non-ADHD children alike.

Benefits

The key benefit of the ADHD diet is that it pro- vides the correct types of foods needed to support the nutritional requirements of both the brain and body. It provides the nutrients needed to sustain good growth and development in children, as well as general health promotion for all, whilst excluding potential antagonistic additives. The diet supports other treat-ment strategies, including stimulant medication, and so helps to improve the quality of life and educational possibilities of those individuals affected.

Precautions

Detailed, personalized advice should always be sought from a suitably qualified dietitian, especially when dealing with children. Any nutritional supple-ments should always be taken according to the manufacturers instructions and at the prescribed dosage. If other medication is being taken then advice should be sought from a doctor.

Risks

It has been reported that fish oil supplements when taken along side stimulant medication can exac- erbate hyperactive behavior in some ADHD individuals. In these circumstances, the supplement should continue to be taken and the dosage of the medication be altered accordingly, under the supervision of a Doctor.

Fish oil supplements can also reduce blood clot- ting times and so should not be used if anti-coagulant medication is already being taken. There is no risk attached to the ADHD diet in terms of foods chosen and the diet can be safely fol- lowed by ADHD and non-ADHD individuals alike.

Research and general acceptance

Among the specialists working in this particular field, there is a general consensus that ADHD is a disorder that involves a functional deficiency of the long-chained fats, EPA and DHA that frequently co-exists with zinc and iron deficiencies. Among the wider community there remains a great deal of skepticism about ADHD and the role that diet has in its develop- ment or management. In terms of supplementation, insufficient data is available to formulate a standardized treatment strat- egy and it is unclear whether the micronutrient defi-ciencies are a cause of, or secondary to, ADHD. Other intervention studies have looked in to carnitine sup-plementation and elimination diets but their findings remain inconclusive. It is certainly well accepted that there is still very much more to be learned about ADHD and how nutrients interact to either exacerbate or improve ADHD-related symptoms. More research is planned and hopefully more useful findings will help improve the life of all those affected by this debilitating condition.