Key points
- Several lifestyle factors, including nutrition are thought to worsen ADHD symptoms
- Nutrients like magnesium, zinc, vitamin D, B vitamins, and omega-3 fatty acids show promise for reducing symptoms of ADHD
- Lion’s Mane, L-theanine, tyrosine, and Brahmi are promising, emerging treatments worthy of further research
ADHD is attention-deficit/hyperactivity disorder. It is a mental, behavioural, and neurodevelopmental disorder characterised by inattention, buts of excessive energy, hyperattention, and sometimes impulsivity. While it is likely that ADHD is a natural occurrence and might have some benefits, in the modern environment, it can become socially debilitating.
Several factors are thought to interplay with genes to cause or worsen ADHD, including:
- Tobacco
- Foetal alcohol exposure
- Excessive social and other media
- Lack of exercise
- Lack of exposure to natural environments
- Nutrient deficiencies or insufficiencies
Nutrients and ADHD
Several nutrients have been linked to the incidence and severity of ADHD including magnesium, zinc, vitamin D and omega 3 fatty acids.
It is thought that insufficient levels of vitamin D, EPA, or DHA, or other nutrients, in combination with genetic factors at key periods of infant development might lead to changes in morphology and function of the brain including serotonin activation and function and contribute to the development of ADHD.1
Magnesium
It is also suspected that lipid and magnesium homeostasis may play a role in ADHD symptoms,2 and magnesium deficiency occurs more frequently in children with ADHD.3 A 2019 meta-analysis demonstrated that subjects with ADHD had on average 1.05 mmol/L lower serum magnesium concentration than controls.4 Children with ADHD may also have lower levels of zinc, copper and magnesium compared to both laboratory reference ranges and normal controls in both hair and serum,5 but some reviews have concluded that it’s unclear whether magnesium, iron, selenium, or zinc status are associated with ADHD and its symptoms.6 However, in children with ADHD 6 months of magnesium supplementation (200 mg/day) resulted in a significant reduction in hyperactivity,7 and after 8 weeks of supplementation with an omega-3, zinc, and magnesium-rich snack, children with ADHD experienced significant reductions in inattention, hyperactivity and impulsivity.8
Vitamin D
Low vitamin D status has also been observed in people with ADHD,9 and might be associated with ADHD symptoms.10 A 2017 meta-analysis found a significant difference in vitamin D levels between those with ADHD and controls.11 A randomised controlled trial of 6-to-13-year-olds found that 1000 iu of vitamin D per day (for 3 months) resulted in significant improvements vs control in the Conners Parent Questionnaire (CPQ), the Strengths and Difficulties Questionnaire Teacher Version (SDQT), and the Strengths and Difficulties Questionnaire Parent Version (SDQP). The authors concluded that “Vitamin D supplementation not only improves some behavioural problems but may prevent exacerbation in some symptoms of the disorder and reduce impulsivity.”12
B vitamins
In adults, lower concentrations of B2, B6, and B9 were associated with a diagnosis of ADHD, and B2 and B6 with symptom severity.13
Omega 3 fats and other nutrients
- Flax oil and vitamin C might also reduce symptom severity.14
- Fish oil might improve symptoms of ADHD.15
- The herb Brahmi (Bacopa monnieri) might also be of benefit for the treatment of ADHD.16
- Theanine and caffeine might improve cognition in adolescents with ADHD.17
Multinutrient supplementation & ADHD
Research suggests that the use of micronutrients improves overall function, reduces impairment and improves inattention, emotional regulation and aggression (but not hyperactive/impulsive symptoms), in children with ADHD without significant adverse effects.18 A 1-year follow up of this study also showed that “For the small number of participants who stayed on micronutrients, the benefits conferred through the controlled trial were maintained.”19 A recent (2021) trial solidified findings previously reported by Rucklidge et al. The Clinical Global Impression (CGI-I) response was 54% in those treated with all essential vitamins and minerals at or above recommended dietary allowance amounts compared to 18% of those taking placebo. Interestingly, those treated also had a significant increase in growth of 6 mm more than the placebo group.
Anecdotal experience
Clinically, we have seen benefits from combination therapy of Lion’s Mane mushroom (Hericium erinaceus and related species), tyrosine, and L-theanine.
References
1. Patrick RP, Ames BN. Vitamin D and the omega-3 fatty acids control serotonin synthesis and action, part 2: relevance for ADHD, bipolar disorder, schizophrenia, and impulsive behavior. The FASEB Journal. 2015;29(6):2207-22.
2. Irmisch G, Höppner J, Reis O, Haessler F, Weirich S. P01-214 – Modified Magnesium and Lipoproteins in Children with Attention Deficit Hyperactivity Disorder (ADHD). European Psychiatry. 2010;25(S1):1-.
3. Kozielec T, Starobrat-Hermelin B. Assessment of magnesium levels in children with attention deficit hyperactivity disorder (ADHD). Magnesium research. 1997;10(2):143-8.
4. Effatpanah M, Rezaei M, Effatpanah H, Effatpanah Z, Varkaneh HK, Mousavi SM, et al. Magnesium status and attention deficit hyperactivity disorder (ADHD): A meta-analysis. Psychiatry Research. 2019;274:228-34.
5. Elbaz F, Zahra S, Hanafy H. Magnesium, zinc and copper estimation in children with attention deficit hyperactivity disorder (ADHD). Egyptian Journal of Medical Human Genetics. 2017;18(2):153-63.
6. Robberecht H, Verlaet AAJ, Breynaert A, De Bruyne T, Hermans N. Magnesium, Iron, Zinc, Copper and Selenium Status in Attention-Deficit/Hyperactivity Disorder (ADHD). Molecules (Basel, Switzerland). 2020;25(19):4440.
7. Starobrat-Hermelin B, Kozielec T. The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactivity disorder (ADHD). Positive response to magnesium oral loading test. Magnesium research. 1997;10(2):149-56.
8. Ramya R, Preetha N, Hemamalini A. The Effect Of Supplementation Of Omega‐3, Zinc And Magnesium Rich Snack In Reducing The Neurobehavioral Symptoms In Children With Attention Deficit Hyperactivity Disorder (ADHD)‐A Pilot Study. Journal of Indian Dietetics Association. 2021;39(1):1-7.
9. Rucklidge JJ, Johnstone J, Gorman B, Boggis A, Frampton CM. Moderators of treatment response in adults with ADHD treated with a vitamin–mineral supplement. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2014;50:163-71.
10. Hemamy M, Askari G. Vitamin D Status and Its Association with Attention Deficit Hyperactivity Disorder (ADHD) in Children. Journal of Nutrition and Food Security. 2017;2(4):259-61.
11. Kotsi E, Kotsi E, Perrea DN. Vitamin D levels in children and adolescents with attention-deficit hyperactivity disorder (ADHD): a meta-analysis. ADHD Attention Deficit and Hyperactivity Disorders. 2019;11(3):221-32.
12. Naeini AA, Fasihi F, Najafi M, Ghazvini MR, Hasanzadeh A. The effects of vitamin D supplementation on ADHD (Attention Deficit Hyperactivity Disorder) in 6–13 year-old students: A randomized, double-blind, placebo-controlled study. European Journal of Integrative Medicine. 2019;25:28-33.
13. Landaas ET, Aarsland TIM, Ulvik A, Halmøy A, Ueland PM, Haavik J. Vitamin levels in adults with ADHD. BJPsych open. 2016;2(6):377-84.
14. Joshi K, Lad S, Kale M, Patwardhan B, Mahadik SP, Patni B, et al. Supplementation with flax oil and vitamin C improves the outcome of Attention Deficit Hyperactivity Disorder (ADHD). Prostaglandins, Leukotrienes and Essential Fatty Acids. 2006;74(1):17-21.
15. Alshammari MAS, Ross Watson R. Chapter 16 – The Effectiveness of Fish Oil as a Treatment for ADHD. In: Watson RR, De Meester F, editors. Omega-3 Fatty Acids in Brain and Neurological Health. Boston: Academic Press; 2014. p. 187-99.
16. Sarris J, Kean J, Schweitzer I, Lake J. Complementary medicines (herbal and nutritional products) in the treatment of Attention Deficit Hyperactivity Disorder (ADHD): A systematic review of the evidence. Complementary Therapies in Medicine. 2011;19(4):216-27.
17. Kahathuduwa CN, Wakefield S, West BD, Blume J, Dassanayake TL, Weerasinghe VS, et al. Effects of l-theanine–caffeine combination on sustained attention and inhibitory control among children with ADHD: a proof-of-concept neuroimaging RCT. Scientific Reports. 2020;10(1):13072.
18. Rucklidge JJ, Eggleston MJF, Johnstone JM, Darling K, Frampton CM. Vitamin-mineral treatment improves aggression and emotional regulation in children with ADHD: a fully blinded, randomized, placebo-controlled trial. Journal of Child Psychology and Psychiatry. 2018;59(3):232-46.
19. Rucklidge JJ, Frampton CM, Gorman B, Boggis A. Vitamin–Mineral Treatment of ADHD in Adults:A 1-Year Naturalistic Follow-Up of a Randomized Controlled Trial. Journal of Attention Disorders. 2017;21(6):522-32.
