Food and Behaviour Research

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Nutrition in the Management of ADHD: A Review of Recent Research

Lange KW, Lange KM, Nakamura Y, Reissmann A (2023) Curr Nutr Rep 12(3) 383-394. doi: 10.1007/s13668-023-00487-8. 

Web URL: Read this and related articles via Pubmed here. Free full text of this article is available online

Abstract:

Purpose of review: 

Various nutrients and diet quality have been suggested to be involved in the pathophysiology of ADHD.

The purpose of this review was to examine data from recent cohort studies and dietary interventions to determine whether nutrition may play a role in the management of ADHD.

Recent findings: 

Preliminary evidence suggests that minerals might have beneficial effects on ADHD symptomatology. Probiotics might offer novel strategies to prevent or treat ADHD. Inverse associations between adherence to "healthy" diets and ADHD symptoms have been observed.

Children with ADHD responding to the few-foods diet (or oligoantigenic diet) with an elimination of individually identified food items show substantially improved behavior and cognitive functioning. Evidence from recent research does not allow any recommendations regarding the use of micronutrients or probiotics in the management of ADHD. The few-foods diet may become an additional therapeutic option for children with ADHD.

Keywords: 

ADHD; DASH diet; Dietary patterns; Elimination diet; Few-foods diet; Iron; Lifestyle; Magnesium; Management; Mediterranean diet; Micronutrients; Minerals; Nutrition; Oligoantigenic diet; Probiotics; Vitamin D; Vitamins; Zinc.

FAB RESEARCH COMMENT:

The role of nutrition and diet in the management of ADHD remains controversial - and not part of standard clinical practice in most countries, for what is usually claimed to be 'insufficient evidence'.

However, the evidence that poor nutrition impairs brain development and function more generally is unequivocal. And the evidence that dietary factors can contribute to 'ADHD-type symptoms' (in children - or adults - with or without a formal diagnosis) continues to increase with each year that goes by.

NB - This new review summarises only the most recent evidence - specifically, "original research articles, cohort studies, interventional trials, systematic reviews, and meta-analyses published from 2018 to 2022".

While a focus on this restricted time window is completely understandable given the sheer size of the research literature on this topic, it obviously means that the findings are to some extent influenced by recent trends, rather than reflecting the totality of the available evidence.  

Good evidence from population and case-control studies shows that 'dietary quality' tends to be lower in individuals with ADHD, but as 'assocation' studies can never provide definitive evidence of causality, the main focus is on the evidence to date from clinical trials, which can directly assess causal effects of diet or nutritional intervention on behaviour.

As the authors highlight, carefully controlled treatment trials have repeatedly shown that the behavioural and cognitive difficulties of many children with ADHD can be significantly improved by diets that exclude specific foods (and/or additives) to which they react badly.

High-quality evidence of benefits from the use of so-called 'oligo-antigenic' or 'few foods' diets for managing ADHD symptoms goes back more than 40 years now - and indicates that a large proportion of children diagnosed with ADHD could benefit from this approach.

As ever, the difficulties lie in the practical application of suitable 'exclusion diets' - as specialist professional help (from a dietitian or regiustered nutritionist) is usually needed - both to identify the 'offending' foods, and to help parents to plan and supervise a diet that is nutritionally adequate, and acceptable.

Of the many studies investigating food supplements (vitamins, minerals, fatty acids or probiotics) recent evidence points to specific nutrients such as zinc and Vitamin D.