By Dr. Meghan van Drimmelen | Naturopath Victoria BC

Parenting a child with ADHD (attention-deficit hyperactivity disorder) can be overwhelming and frustrating.  Academics may be compromised, listening skills at home may be causing family tension, and emotional stress may take over your child as you’re trying to navigate your way through ADHD assessments and treatment options.

You are not alone.  It is estimated that 3-5% of school-aged children have ADHD.  This means that in a standard classroom, or 25–30 children, at least one child will suffer from ADHD.[1]  This disorder is characterized by 3 hallmark symptoms – inattention, hyperactivity, and impulsivity – of which the presence and severity vary among individuals.  These symptoms can present before the age of 7, and may persist all throughout a person’s life.[2] 

Naturopathic medicine offers evidence-based natural therapies that target the underlying cause of this disorder. ADHD is the result of neurotransmitter and neuroendocrine imbalances - the 5 neurotransmitters and hormones affected are norepinephrine, dopamine, serotonin, cortisol, and insulin. Nutritional deficiencies and lifestyle factors can influence these imbalances.  Further, food sensitivities and imbalances in gut microflora can contribute to malabsorption of nutrients. 

A Naturopathic Doctors Approach to Treating ADHD

Below you will find my 6-step approach for managing ADHD naturally. Although this article is targeted to the pediatric population, these treatment principles can also be applied to managing ADHD in adults.

1) Promote Quality Sleep

Sleep problems are common in children with ADHD.  Often there is resistance to go to bed, due to a feeling of being ‘wired’ or not being able to fall asleep.  Sleep deprivation contributes to cortisol, insulin and norepinephrine imbalances.  Thus, it is not surprising that inadequate sleep contributes to worsening of daytime symptoms of ADHD.[9],[10],[11] Ideally, school-aged children should be sleeping 10-12 hours per night, while adolescents should be sleeping 8-10 hours per night.  Creating a consistent calming nighttime routine that includes time away from computers, Ipads and TVs, and incorporating warm Epson salt baths, reading or journaling may help.  With the guidance of your health care provider, natural sleeping aids such as melatonin,[12] or L-theanine[13] can also safely be used in children with ADHD to help promote restful sleeps.

2) Encourage Regular Exercise

Physical activity boosts serotonin levels and balances cortisol, dopamine and insulin. Beginning the day with a quick work-out consisting of jumping jacks, running up and down the stairs, or briskly walking to school will help balance these hormones, and prime the brain for learning.  A minimum of 30 minutes of exercise per day has been shown to improve focus and concentration in children with ADHD.[14]

3) Balance Blood Sugar & Insulin

Studies show that excessive sugar intake, and diets rich in processed foods are linked to ADHD.[15],[16] In my practice I generally recommend focusing on a whole foods Mediterranean-style diet that includes lots of brightly coloured fruits and veggies, whole grains, and healthy proteins and fats such as fish, poultry, legumes, nuts, seeds and olive oil. I emphasize limiting sugar to special occasions, and avoiding processed foods all together. This well-rounded diet will help to balance blood sugar and insulin throughout the day and calm the nervous system.

4) Correct Nutrient Deficiencies

Vitamins and minerals influence many metabolic pathways, which control the overall balance of neurotransmitters and hormones in the body.  The particular nutrients that are pertinent to ADHD include B vitamins, magnesium, iron, zinc, omega 3 fatty acids, and vitamin D.[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30]

In my practice I offer blood testing for vitamins and minerals and other nutrient markers that are readily available through conventional laboratories – including iron, vitamin B12, zinc, and vitamin D.  In cases of deficiency, I will recommend supplementation based on the child’s level of deficiency, age and weight. I also offer guided therapeutic trials of nutrient therapy for those vitamins and minerals we cannot readily test for through the blood.

5) Remove Food Sensitivities & Intolerances

Many studies have shown that eliminating common food sensitivities and intolerances from the diet for a period of 2-4 weeks improves symptoms of ADHD in some children.[31] When pooling the evidence together, it is estimated that 25-30% of children with ADHD will have at least some symptom improvement with an elimination diet, and 10% will have full symptom remission.[32]  The most common foods that have been shown to aggravate ADHD symptoms include wheat, dairy, egg, chocolate, orange, tomato, and food additives and dyes.[33]

Because food additives and dyes have no nutritional value, I always recommend fully eliminating these compounds from the diet. For children who have ADHD, and additional digestive or allergic symptoms, I will also guide the family through an elimination and challenge diet with the common food triggers listed above. In some cases I will recommend IgG food sensitivity testing to fine tune the foods the child is reacting to.

Food additives to avoid:

• All artificial colours

• All artificial flavours

• All artificial sweeteners, including aspartame, acesulfame K, neotame, saccharin, sucralose

• Sodium benzoate

• Butylated hydroxyanisole and Butylated hydroxytoluene

• Carrageenan

• Monosodium or monopotassium glutamate

• Any hydrolyzed, textured or modified protein

6) Correct Microbiome Imbalances

The bacteria in our gut not only regulate digestive processes and the absorption of nutrients, they also modulate our immune system and have an affect on our nervous system and brain. Having said this a growing number of researchers have started to study the link between neuropsychiatric disorders such as ADHD and the microbiota.[34],[35],[36]  

In my practice, I will recommend a trial of probiotics in children with ADHD that also have digestive and immune symptoms, or if a nutritional deficiency has been diagnosed.  I will also recommend fermented foods that naturally contain probiotics, as well as foods that help to promote the maintenance and growth of healthy bacteria in the gut (ie. prebiotic foods – garlic, onion, leeks, asparagus, bananas, Jerusalem artichoke, dandelion greens).

In health and happiness,

Dr. Meghan van Drimmelen, ND

References:

[1] Mental Health Canada. “Diseases and Disorder – ADHD.” www.mentalhealthcanada.com

[2] American Academy of Pediatrics.  Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement.  “Clinical practice guideline: treatment of school-aged child with attention-deficit/hyperactivity disorder.”  Pediatrics 2001; 108(4):1033-44.

[9] Moreau V et al. “Sleep, attention, and executive functioning in children with attention deficit/hyperactivity disorder.” Arch Clin Neuropsychol. 2013 Nov;28(7):692-9.

[10] Maski KP et al. “Sleep deprivation and neurobehavioural functioning in children.”  Int J Psychophysiol. 2013 Aug;89(2):259-64.

[11] Gruber R et al. “Impact of sleep restriction on neurobehavioural functioning of children with attention deficit hyperactivity disorder.” Sleep. 2011 Mar 1;31(3):315-23.

[12] Hoebert M et al. “Long-term follow-up of melatonin treatment in children with ADHD and chronic sleep onset insomnia.” J Pineal Res. 2009 Aug;47(1):1-7.

[13] Lyon et al. “The effects of L-theanine (Suntheanine) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double bling, placebo-controlled clinical trial.” Altern Med Rev. 2001 Dec;16(4):348-54.

[14] Grassmann V et al. “Possible Cognitive Benefits of Acute Physical Exercise in Children With ADHD: A Systematic Review.” J Atten Disord. 2014 Mar 12.

[15] Johnson RJ et al. “Attention-deficit/hyperactivity disorder: is it time to reappraise the role of sugar consumption?” Postgrad Med. Sept;123(5):39-49.

[16]  Wiles NJ et al. “’Junk food’ diet and childhood behavioural problems: results from the ALSPAC cohort.” Eur J Clin Nutr. 2009 Apr;63(4):481-8.

[17] David Kennedy. “B Vitamins and the Brain: Mechanisms, Dose and Efficacy – A Review.” Nutrients. 2016 Jan 28.

[18] van Mil NH et al. “DNA methylation profiles at birth and child ADHD symptoms.” J Psychiatr Res. 2014, Feb;49:51-9.

[19] Mousain-Bosc M et al. “Magnesium VitB6 intake reduces central nervous system hyperexcitability in children.”  J Am Coll Nutr. 2004 Oct;23(5).

[20] Mousin-Bosc M et al. “Improvement of neurobehavioural disorders in children supplemented with magnesium-vitamin B6. I. Attention deficit hyperactivity disorders.” Magnes Res. 2006 Mar;19(1):46-52.

[21] Konofal E et al. “Effects of iron supplementation on attention deficit hyperactivity disorder in children.” Pediatr Neurol. 2008 Jan;38(1):20-6.

[22] Cortese S et al. “ Attention-deficit/hyperactivity disorder, Tourette’s syndrome, and restless legs syndrome: the iron hypothesis.” Med Hypotheses. 2008;70(6):1128-32.

[23] Soto-Insuga V et al. “Role of iron in the treatment of attention deficit-hyperactivity disorder.” An Pediatr (Barc). 2013 Oct; 79(4):230-5.

[24] Bilici M et al. “Double-blind, placebo-controlled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder.” Prog Neuropsychopharmacol Biol Psychiatry. 2004 Jan;28(1):181-90.

[25] Dodig-Curkovic K et al. “The role of zinc in the treatment of hyperactivity disorder in children.” Acta Med Croatica. 2009 Oct;63(4):307-13.

[26] Patrick RP et al. “Vitamin D and the omega-3 acids control serotonin synthesis and action, part 2: relevance for ADHD, bipolar disorder, schizophrenia, and impulsive behavior.” FASEB J. 2015 Jun;29(6):2207-22.

[27] Bos DJ et al. “Reduced Symptoms of Inattention after Dietary Omega-3 Fatty Acid Supplementation in Boys with and without Attention Deficit/Hyperactivity Disorder.” Neuropsychopharmacology. 2015 Sept;40(10):2298-306.

[28] Hawkey E et al. “Omega-3 fatty acid and ADHD: blood level analysis and meta-analytic extension of supplementation trials.” Clin Psychol Rev. 2014 Aug:34(6):496-505.

[29] Kamal M et al. “Is high prevalence of vitamin D deficiency a correlate for attention deficit hyperactivity disorder.” Atten Defic Hyperact Disord. 2014 Jun;6(2):73-8.

[30] Goksugar SB et al. “Vitamin D status in children with attention-deficit-hyperactivity disorder.” Pediatr Int. 2014 Aug;56(4):515-9.

[31] Joel T Nigg et al. “Meta-Analysis of Attention-Deficit/Hyperactivity Disorder or Attention-Deficit/Hyperactivity Disorder Symptoms, Restriction Diet, and Synthetic Food Color Additives.” J Am Acad Child Adolesc Psychiatry. 2012 Jan; 51(1):86-97.

[32] Joel T Nigg et al.  “Restriction and Elimination Diets in ADHD Treatment.” Child Adolesc Psychiatr Clin N Am. 2014 Oct;23(4):937-953.

[33] Carter CM et al. “Effects of a few food diet in attention deficit disorder.” Arch Dis Child. 1993 Nov;69(5):564-8.

[34] Anastasia I Petra et al. “Gut-microbiota-brain axis and effect on neuropsychiatric disorders with suspected immune dysregulaion.” Clin Ther. 2015 May 1;37(5):984-995.

[35] Emeran M et al. “Gut/brain axis and the microbiota.” J Clin Invest. 2015 Mar 2; 125(3):926-938.

[36] Patty A et al. “A possible link between early probiotic intervention and the risk of neuropsychiatric disorders later in childhood: a randomized trial.” Pediatr Res. 2015 Jun;77(6):823-8.