There
is a growing body of evidence implicating diet in a variety of chronic
conditions including the commonly diagnosed attention deficit disorder
(ADD). Simple meal modification can be the difference between a normal
childhood and years of difficult behavior or behavior-modifying drugs.
Attention
deficit disorder is the fastest-growing childhood disorder in the United
States. There is also a corresponding condition called
attention deficit hyperactivity disorder (ADHD), or ADD with
hyperactivity.
By January 1998,
about 4 million children--an astounding 10 percent of the entire
school-age population--were diagnosed with either ADD or ADHD. More
alarming, 13 million adults suffer from ADD or ADHD, bringing the total to
17 million Americans struggling with these conditions.
"With the
exception of AIDS, there are few examples of such a rapid spread of a
serious condition in recent years," Gene Haislip, a former deputy
assistant administrator at DEA says. And Haislip wonders, "Why are we
rushing to feed stimulants [such as methylphenidate in the form of Ritalin TM]
to children?"
The inattentive ADD
child is often more difficult to diagnose because inattentive behavior is
not as obvious as hyperactivity. Nevertheless, the inability to get
started or finish tasks jeopardizes the child's functioning both at home
and at school. The inattentive ADD individual procrastinates and rarely
completes anything. This kind of ADD is the most likely to persist into
adulthood, affecting a person's ability to succeed in a career or
relationships.
The hyperactive or
impulsive youngster attracts attention by constantly disturbing others.
Children with this kind of ADHD can pay attention. In fact, they engage
themselves for hours in tasks that interest them. Adults with hyperactive
or impulsive behaviors are always on the go and constantly in motion, but
they get things done. However, they tend to be impatient and quick to fly
off the handle.
Children and
adolescents with combined ADHD are often unpopular because they don't wait
their turn and frequently butt into conversations, these children have the
most difficulty succeeding, and their self-esteem takes a constant
beating. They lack responsibility, do not follow instructions, are often
clumsy and awkward, and are likely to have learning disabilities. These
individuals do not readily accept change and can become agitated when
their schedule is upset, because they do not adapt well.
In the 1990s, brain
imaging techniques such as positron-emission tomography (PET) have
provided clues to the causes of ADHD. PET scans have been used to
characterize abnormalities, such as impaired glucose metabolism, seen in
ADHD patients. ADHD has several causes, including nutrition and food
sensitivities, genetic predisposition, neurotransmitter imbalances and
environmental factors, but the emphasis of this article is nutritional
influences.
Diet's
Far-Reaching Effects. Studies are racking up evidence linking diet to both health and
behavior--including ADD and ADHD.
Startling evidence of
the prevalence of poor-quality diets was revealed in the U.S. Department
of Agriculture (USDA) dietary survey of 3,300 U.S. children and
adolescents. The survey showed that less than 1 percent meet the
recommended daily requirements for the five food groups. A whopping 16
percent do not meet any of the requirements.
N.L. Girardi, M.D.,
and colleagues at Yale University School of Medicine in New Haven, Conn.,
studied differences in the response to sugar in 17 ADHD and 11 normal
children. After an all-night fast, the children drank a
glucose beverage containing eight times the sugar the brain uses in one
hour.
Both groups of
children were given a battery of tests three hours after their sugary meal
to measure cognitive performance. ADHD children's PET scans showed
markedly reduced brain activity caused by insufficient glucose for
processing information. Not surprisingly, their test scores were much
worse than the children who did not have ADHD.
By customizing the
diet and supplementing with missing nutrients, the faulty communication in
a child's or an adult's brain can be repaired and behavior modified. This
process begins with understanding how the body uses food and what effects
protein, carbohydrates and fats have on the brain and behavior.
Protein foods are
often poorly digested by ADD and ADHD children, especially if they are
food-sensitive. Some psychiatrists report lessened hyperactive behavior in
their patients after adding a digestive enzyme to each meal. The child
must digest proteins to have a sufficient supply of the amino acid
precursors needed by brain neurotransmitters. I prefer to use the diet to
supply a spectrum of amino acids from protein rather than supplementing
with individual amino acids like L-tyrosine and L-phenylalanine, or the
metabolites melatonin and 5-HTP. Brain chemistry in ADHD patients is
already unbalanced, and the wrong amino acids or metabolites can worsen
the condition.
Dietary carbohydrates
must be from complex, whole-grain sources, and they should be wheat- and
corn-free because these frequently cause reactions in ADHD children.
Complex carbohydrates such as legumes and vegetables supply the glucose
necessary for brain function without the rapid insulin response that
upsets glucose metabolism.
As is well-known by
now, processed and fried foods usually contain saturated, hydrogenated and
trans fats--the wrong kinds of fats. These fats wreak havoc with the fatty
acids needed for the brain's neuron activity. In addition, ADHD children
typically have low docosahexaenoic acid (DHA) levels. DHA is the primary
fatty acid in brain, nerve, eye and heart tissues, where it functions
within cellular membranes to secure the signaling devices for
communication between cells. Typical dietary sources of DHA
are oils from deep-sea cold-water fish, green seafoods, and animal
products.
Children need the
right kind of fats for their rapidly developing brains and nerves and
should be fed smart-fat rather than low-fat diets. The brain is 60 percent
fat, most of which is DHA.. Arachidonic acid (AA), an omega-6 fatty acid,
is also in plentiful supply in brain membranes. Both DHA and AA are
attached to phosphatides in neuronal membranes, forming a network that
holds the neuronal receptors and channels in place. These
channels are the communication devices of neurons.
Too much of the wrong
fats leaves the brain starved for DHA and AA. The brain will grudgingly
substitute the wrong fats into neuronal membranes, but the membrane
architecture is then changed, and the receptors no longer align properly,
which results in garbled and unclear messages. The ADD or ADHD individual
describes the result as similar to having the television tuned into all
channels simultaneously with the volume on high.
The strategy for fats
is to eliminate the bad ones and supply enough essential fatty acids,
particularly DHA, to reconfigure neuronal membranes. The body is better
able to satisfy AA needs, and DHA helps keep the body in balance.
Currently, two ADHD studies are under way, supplementing 300400 mg
DHA per day.
Nutrition:
The Best Medicine. A complete program for an ADD patient includes supplements in addition to
careful meal planning. Noticeable improvement in behavior is often seen
when patients supplement with the following:
B-complex
supplements are required to assist the brain enzymes that process
carbohydrates for energy and to regulate neurotransmitters.
DHA is often
present at lower levels in ADHD children than in normal children, as
mentioned previously. Optimizing levels of this fatty acid has been
clinically shown to improve behavior in ADHD children. Several companies
supply DHA supplements made from micro algae. I do not recommend
supplementing with the fatty acid precursors linoleic and linolenic acid
because neither children nor adults can convert them in sufficient
quantities to meet the body's need for DHA and AA. It's a good idea to
increase consumption of fatty cold-water fish such as salmon, herring and
tuna, rich sources of DHA.
Vitamin C and
proanthocyanidins (found in grape seed extract) are essential for
several brain functions. Vitamin C is needed to manufacture
neurotransmitters, and the proanthocyanidins modify enzymatic activities
including catecholamine transfer enzyme. Proanthocyanidins
also prevent vitamin C from being oxidized or interacting with copper and
iron to produce free radicals. Choosing the correct proanthocyanidin can
be tricky because there are so many generic grape seed extracts.
Zinc and magnesium
supplementation in addition to a multimineral is a good idea because
deficiencies in both zinc and magnesium have been associated with ADHD,
supplementation has reduced hyperactivity. In a Polish study,
of 48 ADHD and 45 normal children, the ADHD group had significantly lower
zinc and fatty acid blood levels.
Nutrition offers
parents what they really want--a way to beat ADD and ADHD. Only nutrition
combined with behavioral therapy can really offer long-term hope parents
need.
Marcia Zimmerman, C.N.,
is founder and CEO of The Zimmerman Group Inc., Alameda, Calif. Zimmerman
is author of The ADD Nutrition Solution: A Drug-Free 30-Day Plan (Henry
Holt/Owl Books, 1999).
