There are a number of effective “alternative” treatments for ADHD. Many of these treatments are defined as alternative simply because they are an alternative to medication, not because they are a complimentary treatment like acupuncture or homeopathy. Particularly, some of the nutritional treatments described below are based on basic Western science and should be evaluated as such.
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One important area of treatment is dietary modification. First, many children with ADHD are “sensitive” to certain foods — most commonly gluten and casein, but sometimes soy, corn, eggs or others. This means that these foods worsen ADHD symptoms in certain children. I use the word “sensitive” rather than “allergic” because these children typically do not have measurable food allergies. Several studies have shown that placing children with ADHD on elimination diets results in substantial improvement in a significant number of children. The latest study, published in the Lancet in 2011, showed that 64 percent of 50 children placed on a strict elimination diet had a highly significant improvement in their ADHD symptoms. This research is dismissed by many ADHD experts, however, despite multiple studies indicating effectiveness. Elimination diets can be difficult for families, but usually children are only sensitive to one or two foods, and the significant improvement in symptoms make it quite worthwhile.
Related to this, it is quite clear that artificial colors, flavors and preservatives often make ADHD symptoms worse. In fact, they can cause children without ADHD to have increased hyperactivity and decreased attention. Several studies have confirmed this. In Europe this research is taken so seriously that foods with certain colors must carry a warning label that says “may have an adverse effect on activity and attention in children.” The research on sugar is not so clear, but it is hard to ignore the fact that many families notice a dramatic worsening in ADHD symptoms when too much sugar is eaten.
Finally, regardless of food sensitivities, it is important that children with ADHD eat a balanced and healthy diet. Too often these children are eating breakfasts and lunches full of sugar and highly processed carbohydrates — think of a Pop-Tart or waffles with syrup. These cause an immediate jump in blood sugar, followed by an outpouring of insulin and a result in low blood sugar, which can cause a child to be jittery, fidgety, irritable and unable to pay attention.
A very simple nutritional intervention is the addition of omega-3 fatty acids to the diet, usually in the form of fish oil. Omega-3 fatty acids are a type of fat that are extremely important to normal neurological function. Interestingly, children with ADHD are generally deficient in omega-3 fatty acids for reasons that are not known. Because of this, a number of studies have been done evaluating whether fish oil supplements can help children with ADHD (it would also work to increase the amount of fish to four to five servings per week, but researchers wisely realized that was unlikely to work for most children). In any case, most studies did show a positive effect, although some did not. Many of the studies were too small to be convincing. When this happens, researchers often do a meta-analysis in which the statistics from all high-quality studies are pooled together, allowing a better evaluation of the data. For omega-3 fatty acids, a meta-analysis was done in 2011 that showed this intervention was “modestly effective” — in fact, about 40 percent as effective as psychostimulants. I would consider this a substantial effect for a supplement that has very few side effects and is fairly inexpensive.
Iron and Zinc
A very interesting nutritional fact that few people are aware of is that children with ADHD have lower levels of iron circulating to their brains than children without ADHD. Several studies have confirmed this. Further research has shown that in those children with low levels of iron, treatment with an iron supplement can have a positive impact on ADHD symptoms.
It is important to note that this is measured by checking “serum ferritin” rather than just a CBC or “blood count.” These children are not anemic, which is what a CBC measures. Since iron can be overdosed, it is important to check a ferritin level before beginning any iron therapy. Recently, MRI studies have shown that children with ADHD have abnormal iron metabolism in their brain and that changing iron metabolism may be one of the ways in which psychostimulants are effective.
There has been similar research, although it as not as clearly proven, about the role of zinc in ADHD. One interesting study showed that giving a zinc supplement decreased the amount of psychostimulant necessary to achieve good results by almost 40 percent.
There are a number of herbal therapies that can have an impact. A study published in 2015 demonstrated that ginkgo biloba, an herb long known for its positive effect on cognition, increased the benefit of methylphenidate by 35 percent.