Question:

What effect does diet have on symptoms of AD/HD?

Answer:

Parents are often eager to find alternatives to medication for treating AD/HD. Being an informed consumer is essential for providing our children with safe and effective treatments. This three-part series on alternative treatments for AD/HD continues with a discussion of diet.

Adjustments to diet can be classified as elimination or supplementary approaches. The theory behind elimination diets is that substances eaten by children can cause changes in their behavior and mood. In fact, scientifically designed research has indicated that diet and nutrition affect brain development in early years. However, according to the American Academy of Pediatrics, “a young child must be significantly malnourished in proteins and calories before brain development is seriously affected, and this level of malnutrition is rare in the United States.”

The Feingold Diet, developed in the 1970’s by allergist Dr. Benjamin Feingold, is an example of an initially promising elimination diet. Dr. Feingold theorized that many children are sensitive to dietary salicylates and artificially added colors, flavors, and preservatives; eliminating these from the diet could improve learning and behavioral problems. Initial positive responses to the diet, unfortunately were based on anecdotal accounts rather than scientific investigation. Few families were able to stick to the Feingold Diet for extended periods of time. As the diet was studied further using scientific methods, results indicated that only about 10% of children with ADHD demonstrated any allergy to food dyes and a mere 2% on the Feingold Diet experienced improved behavior when these food dyes were eliminated. Consider the fact that ADHD occurs in about 7% of the population and that only 2% of this 7%, or slightly more than one tenth of one percent, benefited from elimination of food additives.

In recognition that this very small percentage exists, the American Academy of Pediatrics now recommends screening selected children for food sensitivities but does not recommend the Feingold Diet. More recent research has shown that children who could have behavioral changes due to food reactions are those with inhaled and food allergies coupled with a family history of migraines and food reactivity. In addition, these children usually have health and behavioral problems in addition to AD/HD, often including sleep and neurological difficulties. For these children, the treating physician generally implements the conventional course for food allergies. Foods such as milk, soy, wheat, corn, citrus, and peanuts are eliminated from the diet one at a time for two to four weeks. The process can continue until a potential food sensitivity is identified by documented improvement in the child’s symptoms.

Many parents and teachers report seeing a connection between the amount of sugar consumed and a high activity level in children. The American Academy of Pediatrics has reported one study that revealed a link between high sugar consumption and hyperactive behavior, and there was no evidence that one caused the other or that the behavioral problems were not due to parenting styles or other factors. For example, children often consume high levels of sugar during naturally stimulating activities such as birthday parties or sleepovers. The excitement of the events themselves may contribute to the high activity level. Many subsequent studies have failed to substantiate any connection whatsoever between sugar consumed and hyperactivity or AD/HD symptoms.

In the 1980’s, pediatrician and allergist Dr. William Cook, postulated that hyperactivity and learning problems were caused by chronic candida (yeast) infection. His theory was based on the premise that frequent use of antibiotics could kill the bacteria that normally prevent the spread of this yeast also associated with vaginal infections in women. He also speculated that yeast overgrowth produced toxins that cause AD/HD by weakening the immune system. Since that time, AD/HD has been shown to be a function of problems with brain neurotransmitters not known to be related to immune deficiency. Crook’s claim of a 75% success rate when children were placed on an elimination diet and given megadoses of vitamins was based on his personal observations rather than on scientific study. Today, megadoses of vitamins are known to be potentially dangerous to health and this approach to treating AD/HD is not recommended.

In addition to megadoses of vitamins, other dietary supplements have been claimed to improve symptoms of AD/HD. As mentioned , AD/HD is a brain disorder in which neurotransmitters are not functioning effectively. Nerve cell membranes are composed of phospholipids containing large amounts of polyunsaturated fatty acids (omega-3 and omega-6). Studies to examine the impact of Omega-3 and Omega-6 supplementation have been promising but not conclusive.

Glyconutritional supplements are another product currently being touted as effective for treating AD/HD. Glyconutritional supplements contain basic sccharides necessary for cell communication and formation of glycoproteins and glycolipids. The saccharides are glucose, galactose, mannose, N-acetylneuraminic acid, fucose, N-acetylgalactosamine, and xylose. Two small studies (Dykman and Dykman, 1998 and Dykman and McKinley, 1997) found some reduction in AD/HD symptoms after these supplements were used, but a third study failed to substantiate these claims.

In a review of the research on other supplements, CHADD (Children and Adults with Attention Deficit Disorders) concluded:

• Definitive controlled studies have been done but have not proven the effectiveness of
  • essential fatty acid supplementation
  • glychonutritional supplementation
  • recommended daily allowance (RDA) vitamins
  • single vitamin megadosage
  • herbs.
• Megadose multivitamins ( not RDA vitamins) “have been demonstrated to be probably ineffective of possibly dangers,” and “have not only failed to show benefit in controlled studies, but also carry a mild risk of hepatoxicity and peripheral neuropathy.”
• Zinc, iron and magnesium deficiencies are not associated with symptoms of AD/HD.
• Amino acid supplementation does not appear to be “a promising area fo further exploration.”
• Hypericum, Gingko biloba, Calmplex, Defendol, or pycnogenol have not been found to be effective in treating AD/HD.

Next month: Biofeedback and other therapies

Sources:

Assessing Complementary and Controversial Interventions: CHADD Fact Sheet #6. available at www.chadd.org

Arnold, L.E.(2002) Attention Deficit/Hyperactivity Disorder: State of the Science and Best Practices. Kingston, NJ: Civic Research Institute.

Dykman,K.D., and Dykman, R.A. (1998). Effect of nutritional supplements on attentional-deficit hyperactivity disorder. Integrative Physiological and Behavioral Science, 33, 49-60.

Dykman, K.D. and McKinley, R. (1997). Effect of glyconutritionals on the severity of ADHD. Proceedings of the Fisher Institute for Medical Research, 1, 24-25.

Reiff, Michael I, editor. (2004) ADHD: A complete Authoritative Guide. American Academy of Pediatrics.