Dietary and nutritional treatments for attention-deficit/hyperactivity disorder: current research support and recommendations for practitioners

FAB RESEARCH COMMENT:

This expert review, by leading researchers in the field of ADHD and its management, provides a very helpful summary for practitioners of the clinical trial evidence to date on dietary or nutritional treatments for ADHD. 

As they emphasise, there is a very important distinction to be made between treatments or 'interventions' that are 'Safe, Easy, Cheap and Sensible' (SECS) and those that are 'Risky, Unrealistic, Difficult, or Expensive' (RUDE).

Evidence from randomised, double-blind, placebo-controlled clinical trials (and ideally, systematic reviews and 'meta-analyses' of these) occupy the top position in the so-called 'Hierarchy' of 'Evidence-Based Medicine', because this type of study design is regarded as the 'gold standard' for providing evidence of cause and effect.

However, numerous ethical and practical obstacles to conducting such trials with nutritional or dietary interventions make such evidence difficult (and in some cases, impossible) to obtain in practice.

For treatments that are SECS, it therefore seems more than reasonable that less evidence should be required for these to be offered by practitioners than for treatments that are clearly RUDE. 

From reviewing the available evidence, two nutritional interventions stand out as SECS for children with ADHD, namely

1) Multivitamin and Mineral supplementation at Recommended Daily Intake levels, and
2) Supplementation with (biologically) 'Essential Fatty Acids' - namely the long-chain omega-3 found in fish and seafood (EPA and DHA), together with the special omega-6 fatty acid GLA.

Both have already shown benefits for reducing ADHD-type symptoms in randomised controlled trials (RCT) - and as the authors emphasise, there is a good case for (1) to be used more widely in general medical practice, given the prevalence of at least some nutritional deficiencies in the wider pediatric population.

More clinical trials of (2) would clearly be useful to allow better identification of any subset(s) of children (or adults) diagnosed with ADHD most likely to respond to this approach, and to explore both optimal dosages and formulations. For more information on clinical trials in this area, please see the following list of articles, which is regularly updated:

• Omega-3 and ADHD - Clinical Trials 

As this review also points out, there is already good supporting evidence from RCTs and systematic reviews that two other types of dietary intervention can improve behaviour and attentional problems in children with ADHD-type difficulties.

Avoiding artificial food colourings (AFC) - and possibly some other artificial food additives is one of these.

Clinical trials have found removal of AFCs beneficial in both children with ADHD-type difficulties and children from the general population. This always seems to be downplayed - as it is here - in the management of ADHD for being
- not 'specific' to ADHD - because it has been shown to benefit all children. (But those with ADHD are surely a subset who particularly need all the help they can get from any safe, low cost intervention that is also likely to have general health benefits?) and/or
- 'too difficult' (because despite the high-level scientific evidence, regulatory bodies seem unwilling to take action reduce children's exposure to these completely unnecessary ingredients).

'Exclusion diets' for those children with food intolerances.  

Decades of research show that this seems to apply to a large proportion of children with ADHD - although food intolerances are obviously not confined to this population. However, there is no question that this approach is NOT easy in practice, or very cheap - as professional input and supervision is required.