What is ADHD?
Attention-deficit/hyperactivity disorder (ADHD) is a syndrome diagnosed in many children. The exact percentage of children with ADHD is not known but figures are estimated at about 3-5% of school age children¸ with the incidence being slightly higher in boys. The main symptoms of ADHD are reduced attentiveness and concentration, excessive levels of activity, distractibility and impulsiveness. Some children may be affected by other behavioural problems. Sometimes children outgrow the symptoms or learn to control them; in some cases symptoms may persist into adulthood. ADHD can have a significant effect on families particularly when a child’s ability to learn is compromised. This can have a knock on effect on the child’s self-esteem and put stress on the rest of the family particularly when the child has difficulty focussing on essential activities or controlling impulsive behaviour.
Is there a link with diet?
For some time there has been much controversy regarding whether or not diet can trigger symptoms of ADHD. It was first suggested by Feingold in the mid-1970s that there was a possibility that food additives and natural food constituents could affect children’s behaviour, particularly those with ADHD. Scientists began to look into the theory with further research being conducted. Unfortunately many of the studies are small or flawed, and thus there is little consensus about how such additives might contribute to ADHD symptoms.
Recently the link between diet and additives has been explored in a study in Britain. The results of this study led the UK’s Food Standards Agency to urge food manufacturers to remove six artificial colouring agents from food marketed to children in Britain. They looked at the effects of the preservative sodium benzoate (E211) and six artificial food colourings on hyperactivity in 153 preschoolers (3 years old) and 144 students (8 or 9 years old). For six weeks, the children consumed foods and drinks free of sodium benzoate and the six colouring agents. At certain intervals, the children consumed plain juice or juice containing one of two additive mixes every day for a week. Mix A contained the preservative plus the colourings sunset yellow (E110), carmoisine (E122), tartrazine (E102), and ponceau 4R (E124); mix B contained the preservative plus sunset yellow(e110), carmoisine (E122), quinoline yellow (E104), and allura red AC (E129). The investigators found a mild but significant increase in hyperactivity in both age groups of children, regardless of baseline hyperactivity levels during the weeks when they consumed drinks containing artificial colours.
With the belief by some parents and health professionals that refined sugars trigger hyper-activity, the evidence for this has also been reviewed; however assessing the effect of “sugars” on behaviour can be tricky as there are several different types of sugar added to foods, for example: sucrose, glucose and fructose. Unfortunately there are only a few reliable studies that have been conducted. The studies show that sugars may affect a small number of children. We do know that these days in some cases children are having well over double the recommended daily added sugar intake and so to avoid excess empty calories if for no other reason, families should be aiming for a reduced added sugar intake.
Because fatty acids perform a number of functions in the brain, including helping brain cells to communicate, researchers have explored whether a deficiency of omega-3 fats might contribute to symptoms of ADHD. There are some studies which do show an improvement, none have definitively resolved the question of whether omega-3 or omega-6 supplements might help children with ADHD. Further studies are being conducted to explore this.
Where does this leave the parent of a child with ADHD?
Getting to the bottom of whether you child’s behaviour is affected by diet, can be tricky but not impossible. One of the most important principles to remember is to choose a balanced diet with the correct proportion of macronutrients and micronutrients from meats, wholegrain starches, dairy, fresh fruit & vegetables and the good oils like olive and canola. This will ensure that your child’s diet is providing an optimal source of all the important nutrients and prevent any deficiencies which might exacerbate symptoms of ADHD.
Choose wholegrain cereals as the basis for meals.
These will provide slow release energy and prevent any peaks and troughs in sugar levels which can also affect moods and behaviour. Whole-grains are also rich in b-complex vitamin and minerals
Choose wholegrain and rye breads, cereals, pastas and rice instead of sugary cereals and refined breads
Have meat or meat alternatives twice per day, a portion roughly size of your child’s palm
Try to serve oily fish twice a week to optimise intake of omega-3’s
Try homemade salmon fish cakes or a sardine pate
Opt for fresh fruits fruit, milk or yoghurt and nuts as snacks between meals
These provide slow release energy and are a great source of good fats and minerals
Try fruit kebabs or a homemade fruit smoothie
Avoid excess sugar
Excess refined carbs in the form of excess sugar leads to excess energy which will need to be expended or stored somewhere!!!
Avoid carbonated beverages, fruit juices, cordials, sweets, chocolates, cakes and biscuits – have as a treats on special occasions or a day of the week rather than every day
Consider an exclusion diet if necessary
Preferably do with dietetic and/or medical supervision
Look at avoiding additives particularly in the form of artificial E-numbers (E102, 104, 110, 122, 124, E129) & sodium benzoate (E211) as well as other more specific foods like chocolate if necessary.
In certain cases an appropriate option might be a few foods diet with gradual re-introduction of foods to determine if any are causing symptoms.
- McCann et al (2007) The Lancet DOI:10.1016/S0140-6736(07)61306-3 : Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial
- Diet & ADHD Behaviour CSPI Review (1999)