Note: Prescription medication and Behavior Management (i.e. Parent Training) are first line treatments for kids with ADHD and related challenges. However, parents are always asking us about “natural” approaches. So we’ve invited functional medicine practitioner, Chantell Reagan, to write a series of articles to bring us all up to speed on “alternative” approaches to managing your child’s complex issues. Please consult your child’s physician to explore these ideas further. This is the fourth of five articles. You may want to start with the first articles in the series, “Taking an Integrative Approach to Raising Complex Kids,” “The Gut-Brain Connection in Complex Kids,” and, “Do Food Sensitivities & Allergies Connect to ADHD?” ~ Elaine & Diane
People frequently ask me what they can do nutritionally to improve their symptoms of ADHD. Following is a summary of some of the better-researched vitamins and minerals, and how they can support a child (or adult) struggling with ADHD. As with any treatment, please make sure you know your levels before you blindly start adding supplements to your regimen! It’s critical to work with a doctor or other healthcare professional to get proper testing and understand your lab values. This will help streamline your treatment and prevent you from taking any unnecessary supplements or vitamins.
As mentioned in a previous article, there is an incredibly strong link between gut and brain health. Probiotics remain a powerhouse in repairing overall gut health. It’s easy to obtain probiotics from the diet. I always recommend food sources first, including kefir, kombucha, raw sauerkraut, and low-sugar, grass-fed full-fat yogurt. Homemade or local sources can be especially helpful in providing a wide diversity of bacterial strains.
In addition to food, most people need a little more help in restoring the gut in the form of a probiotic supplement. Here are some specs to help you look for a product that will be effective:
- A high Colony Forming Unit (CFU) count of 10-40 billion CFUs.
- Different bacteria, aiming for 10-30 different strands, including bificobacterium bidifum, bacillus coagulans, saccharomyces boulardii, bacillus subtilis, and lactobacillus rhamnosus.
When you start a new probiotic, remember to go “low and slow.” Probiotics work differently in everyone, so it may take some trial and error to find the right product. Start with a quarter to a half of the recommended dose and work your way up slowly over the course of a week or two. Gas, diarrhea and cramping can occur if started too quickly. Most probiotics are taken twice daily on an empty stomach 2 hours away from food or at bedtime; however, some find it helpful to take with a meal.
Omega 3 Fatty Acids
This powerhouse source of omega-3 fatty acids has been extensively studied in ADHD2. The two fatty acids that are found in fish oils include docosahexaenoic acid (DHA), which supports brain health; and eicosapentaenoic acid (EPA), which helps with inflammation. My favorite food sources include fatty fish like salmon and sardines. There are also plant based sources like flaxseed and hemp, but they are not nearly as absorbable as the animal sources (meaning, you need to take a lot more of them compared to an animal source).
When selecting a supplement, consider finding one that is pure and made in an oxygen-free setting (less oxidation leads to less rancidity). Additionally, check to make sure your brand has undergone third-party testing to ensure quality. While most fish oils on the market today have a 1:1 ratio of EPA to DHA, I recommend that you look for one with a ratio of 7:1 or higher. Follow package instructions, which will vary by product.
Recent studies have shown the benefit of krill oil in improving ADHD and a host of mental health disorders. Though it’s not as well studied as fish oil, it has some properties that make it more appealing to ingest. Since it’s bound in a phospholipid structure (vs. triglyceride for fish oil), it’s more bioavailable to the body. That means it’s better absorbed and a lower dose can be given. It also contains the powerful antioxidant astaxanthin, which also prevents oxidation and rancidity. Dosing hasn’t been fully established yet. Dosing ranges from 320mg/day for children to 500mg/day for adults. Refer to dosing on package instructions.
Though there are 8 B vitamins in total, two play a particularly important role in ADHD. Vitamin B-6 (pyridoxine) is critical in making the neurotransmitter serotonin. Additionally vitamin B-12 (methy B-12) helps to regenerate neurons and the myelin protective sheath.
Food sources include organic, grass-fed poultry and beef, seafood, bananas, leafy green vegetables such as spinach, and potatoes. You may want to work with a practitioner who can recommend individual B-vitamins and suggest dosing. If you do take a B-Complex, follow the package instructions. I suggest taking it in the morning, as it can have a stimulating effect.
According to Carolyn Dean, M.D., up to 80% of Americans could be deficient in magnesium. It is essential for over 300 critical enzyme processes in the body. Magnesium promotes cardiovascular health, has a calming effect on the bowels and can aid in anxiety. Most children who take prescription stimulants are especially susceptible to magnesium depletion, which affects neurotransmitters controlling emotion, hyperactivity and attention. Magnesium is synergistic (or works well) with vitamin B-6 (pyridoxine).
Food sources include leafy greens, cacao, nuts, oysters, mackerel, beans, avocados and bananas.
Fun fact: our bodies like to absorb magnesium in different ways. Try taking a hot bath and dissolve 1-2 cups of Epsom salts, which are a great source of magnesium. Or consider spraying magnesium oil on the bottom of the feet at bedtime. Magnesium citrate is a laxative, so decrease your dose if experiencing any diarrhea or cramping.
It may come as a surprise that many children are deficient in Vitamin D. Optimal levels are needed for bone health as well as immune function.
How can you get more vitamin D? Get outside! Just 15 minutes a day in the sun can boost vitamin D levels. In addition, salmon, mackerel, tuna, sardines, yogurt and milk, egg yolks, cheese and liver are good food sources of vitamin D.
Consider using vitamin D3 supplements, as well. Children one year of age and above: 400 IUs per day, taken with a meal. Adult dosing can range from 1000-10,000 IU/day depending on levels. Your doctor or practitioner can test your levels of this very important vitamin.
Zinc helps in making dopamine, which can affect mood & concentration (a big helper for ADHD symptoms). Adequate levels also support production of melatonin and serotonin. Zinc also converts vitamin B-6 (pyridoxine) into active form. It can also prevent oxidative damage. Finally, zinc can lower copper store, which can also affect ADHD symptoms.
Food sources include oysters, beef & lamb, spinach, pumpkin/squash seeds, cashews, cocoa powder, pork and white mushrooms.
In clinical trials, there was a wide variety of dosing. Per the National Institute of Health, the upper limit daily dose of zinc is as follows: 4mg
(infants to 6 months), 5mg (7-12 mo), 7mg (1-3yo), 12mg (4-8yo), 23mg (9-13yo), 34mg (14-18yo) and 40mg (19 and older). Though this is a common deficiency, I would recommend talking to a practitioner before supplementing.
In the Archives of Pediatrics and Adolescent Medicine, it was noted that 84% of kids with ADHD are deficient in iron vs only 18% in those without the condition. Beef/chicken liver, clams, mollusks, mussels, oysters, beef, sardines, turkey are great food sources. As with zinc, I suggest testing ferritin levels through a practitioner. Too much iron can block zinc, copper, and manganese, so you really want to know your levels before supplementing.
1. Probiotics referenced from the Cleveland Clinic. Accessed February 11, 2016.
2. Gow RV, Hibbeln JR, et al. Current evidence and future directions for research with omega-3 fatty acids and attention deficit hyperactivity disorder. Curr Opin Clin Nutr Metab Care. 2015 Mar;18(2):133-8. Accessed February 11, 2016.
3. Kidd PM. Omega-3 DHA and EPA for cognition, behavior, and mood: clinical findings and structural-functional synergies with cell membrane phospholipids. Altern Med Rev. 2007 Sep;12(3):207-27. Accessed on February 11, 2016
4. Dolina S, Margalit D, et al. Attention-deficit hyperactivity disorder (ADHD) as a pyridoxine-dependent condition: urinary diagnostic biomarkers. Med Hypotheses. 2014 Jan;82(1):111-6. Accessed on February 11, 2016 at: http://www.ncbi.nlm.nih.gov/pubmed/24321736
5. Rucklidge JJ, Johnstone J et al. Moderators of treatment response in adults with ADHD treated with a vitamin-mineral supplement. Prog Neuropsychopharmacol Biol Psychiatry. 2014 Apr 3;50:163-71. February 11, 2016
6. Reynolds E. Vitamin B12, folic acid, and the nervous system. Lancet Neurol. 2006 Nov;5(11):949-60. Accessed on February 11, 2016
7. Dean, C. The Magnesium Miracle. New York, NY; 2003. Magnesium for Health Care Professionals. National Institutes of Health. Accessed on February 11, 2016
8. Patrick RP, Ames BN, et al. Vitamin D and the omega-3 fatty 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. Accessed on February 11, 2016
9. Zinc Safety. Mayo Clinic. Accessed on February 11, 2016
10. Konofal E, Lecendreux M, Arnulf I et al. Iron deficiency in children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med. 2004 Dec;158(12):1113-5. Accessed on February 11, 2016